Statins for children with familial hypercholesterolemia

Statin treatment appears to reduce both total and LDL cholesterol levels in children with familial hypercholesterolemia and it seems to be safe in the short term but long-term safety is unknown.

A Cochrane review included 9 studies with a total of 1 177 children. 2 simvastatin, 1 atorvastatin, and 1 rosuvastatin. The follow-up time on average was only 6 months, and at longest 2 years (in one trial only). Statins reduced the mean low-density lipoprotein cholesterol concentration at all time points. At one month the pooled estimate of the difference in mean relative reductions was -24.59% (95% CI -30.11% to -19.08%; 2 studies, n=125), at 6 months -34.97% (95% CI -37.51% to -32.44%; statistical heterogeneity, I2=86%; 4 studies, n=528) and at one year -26.94% (95% CI -31.64% to -22.23%; statistical heterogeneity, I2=93%; 2 studies, n=254). The difference in mean relative reductions in total cholesterol concentration at the end of the follow-up between those treated with statin and those with a placebo varied from -17% to -32%. The pooled estimate of the difference in mean relative reductions at the end of follow-up was -26.53% (95% CI -28.54% to -24.51%, statistical heterogeneity, I2=88%; 5 studies, n=566).There was no difference between serum aspartate and alanine aminotransferase as well as creatine kinase concentrations at any time-point. The risks of myopathy and clinical adverse events were also similar in both groups. In one study simvastatin was shown to improve flow-mediated dilation of the brachial artery, and in another study treatment with pravastatin for two years induced a significant regression in carotid intima media thickness (-0.01 mm, 95% CI -0.03 to -0.00; 1 study n=211). In general, the intervention and follow-up time was short (median 24 weeks; range from six weeks to two years). Statins reduced the mean low-density lipoprotein cholesterol concentration at all time points (moderate quality evidence). Serum aspartate and alanine aminotransferase, as well as creatinine kinase concentrations, did not differ between treated and placebo groups at any time point (low quality evidence). The risks of myopathy (low quality evidence) and clinical adverse events (moderate quality evidence) were very low and also similar in both groups. In one study simvastatin was shown to improve flow-mediated dilatation of the brachial artery (low quality evidence), and in another study treatment with pravastatin for two years induced a significant regression in carotid intima media thickness (low quality evidence).

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment).

Ədəbiyyat

1. 14;(7):CD006401. ."?>Vuorio A, Kuoppala J, Kovanen PT et al. Statins for children with familial hypercholesterolemia. Cochrane Database Syst Rev 2017;(7):CD006401.