Archief Roodbont

'The younger, the better' for statin initiation in FH

8 August 2007

MedWire News: The earlier statin treatment is started in children with familial hypercholesterolemia (FH), the greater is the reduction in carotid intima-media thickness (IMT) growth, research shows.

"According to our model, IMT after follow-up will increase 0.003 mm in FH patients for each year that statin therapy is postponed," say Jessica Rodenburg (University of Amsterdam, The Netherlands) and colleagues.

The team reports the long-term follow-up of 214 participants in a single-center, randomized, double-blind, placebo-controlled trial. The FH patients, who were aged between 8 and 18 years at baseline, were treated with daily placebo or pravastatin, at 20 mg in children younger than 14 years and 40 mg in older patients.

After 2 years, placebo-treated participants were switched to pravastatin. The current analysis of 186 children, which appears in the journal Circulation, took place after a further minimum 2 years of follow-up, when all patients had been taking pravastatin for at least 2 or 4 years.

During treatment, the children's total cholesterol levels fell by 22.5%, low-density lipoprotein cholesterol levels fell by 29.2%, triglyceride levels fell by 1.9%, and high-density lipoprotein cholesterol levels increased by 3.1%.

The average carotid IMT increased from 0.494 to 0.547 mm during follow-up.

On multivariate analysis, increasing age at statin initiation was associated with greater IMT at follow-up, as was IMT at baseline and being male.

"Although the optimal age at which statin treatment should be started during childhood is unknown, in our opinion statin treatment should be considered for all children who are >8 years of age once FH has been diagnosed," say the researchers.

Longer-term follow-up is needed to assess whether retarding IMT growth with early statin therapy translates into reduced cardiovascular risk as these high-risk patients age, they add.

Circulation 2007; Advance online publication