Kids and Statins: DISCUSSION

23 Feb
2010

DISCUSSION

We are left with these facts about the use of statin drugs in adolescence:

  • Statins are highly effective for the short-term lowering of cholesterol and LDL-C levels.
  • They have a favorable side-effect profile and are well tolerated.

However, their use in this age group also poses these dilemmas:

  • Studies demonstrating reductions in cardiovascular mortality exist exclusively in adults and primarily in secondary prevention studies.
  • It is unknown whether the pleiotropic beneficial effects of statins apply to older children (above 10 years of age) and to adolescents, as demonstrated in adults.
  • Long-term systemic and developmental effects have not yet been assessed in older children or adolescents.

Therefore, dyslipidemia in these older children and adolescents will continue to pose a dilemma to concerned health care professionals. In actual practice, if the adolescent has significant dyslipidemia (total cholesterol, 240 mg/dL; LDL-C above 190 mg/dL) and a strong family history of first-degree relatives with premature cardiovascular disease, we would not hesitate to medically prescribe statins after a failed six-month trial of lifestyle modification. cialis professional

It is the child with borderline values whose total cholesterol level only slightly exceeds the recommended 170 mg/dL and whose LDL-C level exceeds 110 mg/dL (e.g., total cholesterol, 180 mg dL; LDL-C, 140 mg/dL) and no other comorbid risk factors who poses a treatment conundrum.

If premature disease is suspected in the family history, one would certainly consider medical management after failed attempts at lifestyle modification. However, the use of a resin binder, such as cholestyramine (Questran, Par), may adequately achieve results without subjecting patients to the more potent statins. This drug class—the antilipemic agents—inhibits local intestinal absorption of cholesterol without creating problems relating to systemic absorption, hepatic or muscle injury, or the need to monitor blood work; however, its cholesterol-lowering effects are not as potent as those associated with statins.

CONCLUSION

It seems evident that the use of statins for primary prevention of coronary artery disease will benefit older children and adolescents in the same way that it benefits young adults. Prospeccontinued from page 610 tive primary prevention studies with long-term follow-up are needed in the pediatric population to definitively support widespread utilization of appropriate pharmacological management. suhagra 100

It will probably also benefit patients to use the newer, non-invasive modalities such as ultra-fast electron beam CT, cardiac MRI and magnetic resonance angiography (MRA), and intra-vascular ultrasound to monitor the progression or regression of coronary artery disease, with surveillance assessments beginning in childhood.

Finally, it bears repeating that pharmacotherapy should never replace lifestyle modification as the primary focus in the management of dyslipidemia in children.

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