Statins Safe and Effective for Children With Familial Hypercholesterolemia

Dr. Barbara A. Hutten from Academic Medical Center, Amsterdam, The Netherlands, states that,  "When a child has been diagnosed with heterozygous familial hypercholesterolemia, statin treatment should be considered for all children older than 8 years."
Dr. Hutten and colleagues performed a meta-analysis on safety outcomes of randomized placebo-controlled trials which evaluated statin treatment in children and adolescents with HeFH. Compared with placebo, statin therapy reduced total cholesterol a mean 25% and LDL cholesterol a mean 30%, the authors report.

Smaller decreases in ApoB were associated with statin therapy, as were significant increases in HDL cholesterol and ApoA1.

Statin therapy was not associated with an increased risk of an adverse event, the report indicates, and there were no differences in the number of children with marked elevations in lab values between statin and placebo groups.

Height increased slightly more in the statin group than in the placebo group, the investigators say, but there were no significant differences between the groups in sexual development.

"Based on our meta-analysis, we cannot draw any conclusions with respect to a preferred statin for children," Dr. Hutten said. "The number of studies in children is relatively low and not all types and doses of statins have been studied in children as of yet."

"Even though the meta-analysis shows that statin treatment seems safe in children and adolescents, long-term - or actually life-long - safety still needs to be investigated," Dr. Hutten explained. "It is unknown whether the risk reduction at later age differs between various types of statins used during childhood."

"For their actual decision of starting treatment, physicians should balance benefit and risk, based on the personal situation and the risk profile of each individual child, which depends on family history, lipid profile, lifestyle, etc.," Dr. Hutten said. "Also, patients' and/or parents' preferences may play a role in the decision when to start treatment."

"Furthermore," Dr. Hutten cautioned, "the minimal age of children in the studies included in the meta-analyses was 8 years, and we cannot make any recommendations for children below this age."
Arterioscler Thromb Vasc Biol 2007;27:1803-1810.
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