Childhood lipid treatment guidelines ‘not evidence-based’
MedWire News: Guideline recommendations for lowering lipid levels in children with familial hypercholesterolemia (FH) are not based on clear evidence, say the authors of a systematic review.
The American Heart Association and the American Academy of Pediatrics (AAP) both recommend a LDL cholesterol treatment target of 130 mg/dl (3.4 mmol/l) in children with FH. The AAP further recommends statins as a first-line treatment drug in children as young as 8 years.
In their review and meta-analysis, which included seven studies involving 884 patients, Raanan Shamir (Schneider Children’s Medical Center, Petah-Tikva, Israel) and colleagues found just one study that used a target LDL cholesterol level. In this study, 60% of children taking atorvastatin and no patient taking placebo reached a target LDL cholesterol level of 130 mg/dl (3.4 mmol/l).
The study did not assess any surrogate markers of atherosclerosis, however. Just two studies looked beyond lipid profiles – one evaluated carotid intima-media thickness, finding a borderline difference between statin and placebo treatment, and one studied flow-mediated dilation, finding significant improvements with statin versus placebo treatment.
All studies that reported total and LDL cholesterol and apolipoprotein (apo) B levels found significant reductions with statin versus placebo treatment. The studies reported variable effects of statin treatment on high-density lipoprotein cholesterol and apo A levels.
The statins under study were atorvastatin, simvastatin, lovastatin, and pravastatin.
“Thus, the AAP recommendation to consider statins as a first-line drug treatment for hypercholesterolemia is evidence based,” say Shamir et al in the Archives of Disease in Childhood.
“However, there is no firm evidence regarding when to start this treatment or what target LDL cholesterol level should be obtained.”
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By Eleanor McDermid