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Efficacy and Safety of Statin Therapy in Children With Familial Hypercholesterolemia

Context Children with familial hypercholesterolemia have endothelial dysfunction and increased carotid intima-media thickness (IMT), which herald the premature ath- erosclerotic disease they develop later in life. Although intervention therapy in the causal pathway of this disorder has been available for more than a decade, the long-term efficacy and safety of cholesterol-lowering medication have not been evaluated in children.

Objective To determine the 2-year efficacy and safety of pravastatin therapy in chil- dren with familial hypercholesterolemia.

Design Randomized, double-blind, placebo-controlled trial that recruited children be- tween December 7, 1997, and October 4, 1999, and followed them up for 2 years.

Setting and Participants Two hundred fourteen children with familial hypercho- lesterolemia, aged 8 to 18 years and recruited from an academic medical referral cen- ter in the Netherlands.

Intervention After initiation of a fat-restricted diet and encouragement of regular physical activity, children were randomly assigned to receive treatment with prava- statin, 20 to 40 mg/d (n=106), or a placebo tablet (n=108).

Main Outcome Measures The primary efficacy outcome was the change from base- line in mean carotid IMT compared between the 2 groups over 2 years; the principal safety outcomes were growth, maturation, and hormone level measurements over 2 years as well as changes in muscle and liver enzyme levels.

Results Compared with baseline, carotid IMT showed a trend toward regression with pravastatin (mean [SD], −0.010 [0.048] mm; P=.049), whereas a trend toward pro- gression was observed in the placebo group (mean [SD], +0.005 [0.044] mm; P=.28). The mean (SD) change in IMT compared between the 2 groups (0.014 [0.046] mm) was significant (P=.02). Also, pravastatin significantly reduced mean low-density li- poprotein cholesterol levels compared with placebo (−24.1% vs +0.3%, respectively; P .001). No differences were observed for growth, muscle or liver enzymes, endo- crine function parameters, Tanner staging scores, onset of menses, or testicular vol- ume between the 2 groups. Conclusion Two years of pravastatin therapy induced a significant regression of ca- rotid atherosclerosis in children with familial hypercholesterolemia, with no adverse effects on growth, sexual maturation, hormone levels, or liver or muscle tissue.

Context Children with familial hypercholesterolemia have endothelial dysfunction and increased carotid intima-media thickness (IMT), which herald the premature ath- erosclerotic disease they develop later in life. Although intervention therapy in the causal pathway of this disorder has been available for more than a decade, the long-term efficacy and safety of cholesterol-lowering medication have not been evaluated in children. Objective To determine the 2-year efficacy and safety of pravastatin therapy in chil- dren with familial hypercholesterolemia. Design Randomized, double-blind, placebo-controlled trial that recruited children be- tween December 7, 1997, and October 4, 1999, and followed them up for 2 years. Setting and Participants Two hundred fourteen children with familial hypercho- lesterolemia, aged 8 to 18 years and recruited from an academic medical referral cen- ter in the Netherlands. Intervention After initiation of a fat-restricted diet and encouragement of regular physical activity, children were randomly assigned to receive treatment with prava- statin, 20 to 40 mg/d (n=106), or a placebo tablet (n=108). Main Outcome Measures The primary efficacy outcome was the change from base- line in mean carotid IMT compared between the 2 groups over 2 years; the principal safety outcomes were growth, maturation, and hormone level measurements over 2 years as well as changes in muscle and liver enzyme levels. Results Compared with baseline, carotid IMT showed a trend toward regression with pravastatin (mean [SD], −0.010 [0.048] mm; P=.049), whereas a trend toward pro- gression was observed in the placebo group (mean [SD], +0.005 [0.044] mm; P=.28). The mean (SD) change in IMT compared between the 2 groups (0.014 [0.046] mm) was significant (P=.02). Also, pravastatin significantly reduced mean low-density li- poprotein cholesterol levels compared with placebo (−24.1% vs +0.3%, respectively; P .001). No differences were observed for growth, muscle or liver enzymes, endo- crine function parameters, Tanner staging scores, onset of menses, or testicular vol- ume between the 2 groups. Conclusion Two years of pravastatin therapy induced a significant regression of ca- rotid atherosclerosis in children with familial hypercholesterolemia, with no adverse effects on growth, sexual maturation, hormone levels, or liver or muscle tissue.
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