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Are treatment targets for hypercholesterolemia evidence based? Systematic review and meta-analysis of randomised

Y Lebenthal1, A Horvath, P Dziechciarz

  • 1The Combined Lipid Clinic, Schneider Children's Medical Center, Petah Tikva, Israel.

Archives of Disease in Childhood
|June 3, 2010
PubMed

Insights

Statin therapy effectively lowers LDL cholesterol in children with familial hypercholesterolemia but lacks evidence for optimal treatment targets. Further research is needed to define specific guidelines for this high-risk group.

Area of Science:

  • Pediatric Cardiology
  • Pharmacology
  • Genetics

Background:

  • Familial hypercholesterolemia (FH) is a genetic disorder leading to high LDL cholesterol levels.
  • Early intervention is crucial to prevent cardiovascular disease in children with FH.
  • Current treatment guidelines for pediatric FH lack specific targets for statin therapy.

Purpose of the Study:

  • To review evidence on target age, intervention levels, and target values for LDL cholesterol in children with FH.
  • To evaluate the efficacy of statin therapy in pediatric FH patients.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs).
  • Searched databases (PubMed, Medline, CINAHL, Cochrane Reviews) from 1966 to 2007.
  • Included studies on statin therapy in children and adolescents aged 8-18 years.

Main Results:

  • Seven trials with 884 patients were included.
  • Statin therapy significantly reduced total cholesterol, LDL cholesterol, and apolipoprotein B.
  • High-density lipoprotein cholesterol and apolipoprotein A1 levels were significantly increased.
  • Limited evidence exists on achieving LDL cholesterol treatment targets in children.
  • Statins showed potential benefits on surrogate markers of atherosclerosis (carotid intima-media thickness, flow-mediated dilation).

Conclusions:

  • No firm evidence supports specific ages or target LDL cholesterol levels for statin initiation in pediatric FH.
  • Current recommendations favoring statins are evidence-based.
  • Further studies on high-risk pediatric groups and composite endpoints are needed to refine treatment guidelines.
Abstract

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