Multiple Lipid-lowering Treatment in Pediatric Patients with Hyperlipidemia

Claudia      Stefanutti; Fabio      Mazza

Abstract

256 pediatric patients with primary hyperlipidemia aged 14.2 ± 8.5 years (females: 155; males:101) seen in our lipid clinic were evaluated retrospectively to assess the effect of multiple lipid-lowering treatment (diet only, diet+glucomannan 1.000 mg/day (G), diet+ezetimibe (E) 10 mg/day and diet+atorvastatin (A) 10 mg/day). The patients were assigned to four groups according to their type of treatment: A-Diet (#82; age 12.7 ± 8 years; females 52, males:30); B-Diet+G (#78; age 13.3 ± 9 years; females 61, males 17); C-Diet+E 10 mg/day (#50; age 14.5 ± 7 years; females 31, males 19); D-Diet+A 10 mg/day (#46; age 16.4 ± 10 years; males 35, females 11). The follow-up visits were at 3, 6 and 9 months, respectively. The time period considered was of 9 months. The results obtained in the four groups after 9 months of treatment are given below:

Group A: Total Cholesterol (TC) (-20%), LDL-Cholesterol (LDLC) (-26%), triglycerides (TG) (-25%), nonHDLCholesterol (nonHDLC) (-26%) levels, and TC/HDLC ratio (-21%) were statistically significant reduced (all: P<0001). HDLC was not significantly increased (+2%). The body weight (BW) mean change in the group was statistically significant (-22%; P0.001).

Group B: TC (-24%), LDLC (-32%), TG (-29%), nonHDLC (-32%) levels and TC/HDLC (-26%) were significantly decreased (all: P0.001). HDLC showed a -2.3% not significant decrease. The BW mean change was not statistically significant (-18%).

Group C: TC (-36%), LDLC (-51%), nonHDLC (-45%) levels and TC/HDLC (-38%) were significantly decreased (all: P0.001). HDLC (+4%) was only slightly increased, and TG (-16%) decreased, but the changes were not statistically significant. The BW mean change was not statistically significant (-15%).

Group D: TC (-47%), LDLC (-63%), TG (-23%) and nonHDLC (-58%) levels and TC/HDLC (-50%) showed a statistically significant reduction (all: P0001). HDLC concentration in plasma showed only a slight not significant reduction (- 4%). The BW mean change was statistically significant (-20%; P0.001).

Hyperlipidemia in children can be successfully treated without side effects. The most severe hyperlipidemia is, the most appropriate treatment (diet only,or diet+G, or diet+drugs) is to be given. The reduction of TC/HDLC ratio in childhood prevents future increase of cardiovascular risk in adulthood.

Keywords: Dyslipidemia in children, dietary and drug treatment in childhood, polygenic and monogenic dyslipidemia, glucomannan, ezetimibe, atorvastatin, cardiovascular risk, overweight in children