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(Circulation. 2007;116:594-595.)
© 2007 American Heart Association, Inc.

Editorial

Statins and Children

Whom Do We Treat and When?

Evan A. Stein, MD, PhD

From the Metabolic and Atherosclerosis Research Center, Cincinnati, Ohio.

Correspondence to Evan A. Stein, MD, PhD, Director, Metabolic and Atherosclerosis Research Center, 3131 Harvey Ave, Ste 201, Cincinnati, OH 45229. E-mail esteinmrl@aol.com

Key Words: Editorials • atherosclerosis • imaging • lipids • pediatrics • prevention

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Although the debate about when, whom, and how to treat adults with elevated low-density-lipoprotein cholesterol (LDLc) is essentially over because of a huge amount of data generated by large, clinical end-point, placebo-controlled trials with HMG CoA reductase inhibitors (statins),^1–3 the issue in children and adolescents is not yet settled. In this issue of Circulation, Rodenburg and colleagues⁴ provide important further evidence for both the potential benefit of long-term LDLc reduction and the safety of treating children and adolescents with familial hypercholesterolemia (FH) with statins. This latest trial is an extension of an earlier double-blind, placebo-controlled, 2-year study in just over 200 FH children 8 to 17 years of age at entry.⁵ The initial trial was the first demonstration that even a moderate reduction in LDLc of 25% to 30% resulted in a significant decrease in the rate of thickening of the carotid artery intima thickness and thus moved the focus of lipid-lowering therapy in children from a plasma marker to a well-established anatomic surrogate of atherosclerosis. In the present 2-year extension in which all children were treated with the statin, Rodenburg and colleagues demonstrate that the age at which statin treatment was started was positively associated with carotid artery intima thickness on follow-up and strongly argue that, on the basis of their data, when it comes to treating children with FH, "the earlier, the better." This would by implication include children at least as young as 8 years of age, the entry age in their trial. This is a . . . [Full Text of this Article]

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