Statin Use in Australian Children: A Retrospective Audit of Four Pediatric Hospitals

Gelissen, Ingrid C.; Nguyen, Huy Long; Tiao, Darren K; Ayoub, Rita; Aslani, Parisa; Moles, Rebekah

doi:10.1007/s40272-014-0087-z

Cited by 8 publications

(8 citation statements)

References 25 publications

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“…In these children and adolescents, the mean LDL-C decrease of 36% is similar to decreases previously reported, whether in meta-analyses, clinical trials, or case series ( Table 4 ). 8 , 9 , 14 , 15 , 16 , 17 , 19 , 20 , 21 , 22 , 29 , 30 , 31 , 32 , 33 Self-reported compliance was high, at 91%, although the true compliance rate could not be quantified due to the retrospective nature of the study. These compliance results are comparable to those in other reports from pediatric lipid clinics where patients are referred; initiation of statin therapy in this setting likely reflects enhanced parental/family concern about dyslipidemia and risk for ASCVD.…”

Section: Discussionmentioning

confidence: 97%

Effectiveness and Safety of Statin Therapy in Children: A Real-World Clinical Practice Experience

et al. 2020

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Background Statin use for hypercholesterolemia in children is predominantly reported from short-term clinical trials. In this study, we assess the efficacy and safety of statin treatment in clinical pediatric practice. Methods Records of all patients who began statin treatment at age <18 years and remained on statins for >6 months from 5 pediatric lipid clinics were reviewed. Information at baseline and from all clinic evaluations after statin initiation was recorded, including lipid measurements, statin drug/dose, safety measures (anthropometry, hepatic enzymes, creatine kinase levels), and symptoms. Lipid changes on statin therapy were assessed from baseline to 6 ± 3 months and from 6 ± 3 months to last follow-up with a mixed-effects model, using piecewise linear splines to describe temporal changes, controlling for repeated measures, sex, and age. Results There were 289 patients with median low-density lipoprotein cholesterol (LDL-C) of 5.3 mmol/L (interquartile range [IQR]:4.5–6.5) and mean age of 12.4 ± 2.9 years at statin initiation. Median duration of therapy was 2.7 years (IQR: 1.6–4.5) with 95% on statins at last evaluation. There were significant decreases in total cholesterol, LDL-C, and non–high-density lipoprotein cholesterol (non–HDL-C) from baseline to 6 ± 3 months ( P < 0.001) and from 6 ±3 months to last follow-up ( P < 0.001). Triglycerides and HDL-C were unchanged but the triglyceride to HDL-C ratio decreased significantly by late follow-up. At final evaluation, median LDL-C had decreased to 3.4 mmol/L (IQR:2.8–4.2). No patient had statins discontinued for safety measures or symptoms. Conclusions In real-world clinical practice, intermediate-term statin treatment is effective and safe in children and adolescents with severe LDL-C elevation.

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Section: Discussionmentioning

confidence: 97%

Effectiveness and Safety of Statin Therapy in Children: A Real-World Clinical Practice Experience

et al. 2020

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“…The pick‐up rate for genetic diagnosis was 14 cases but only two clinics provided this service. A set of national quality standards for FH exist in England and Wales as do some audit programmes for countries where genetic testing is universally provided (eg, Wales, Scotland, Northern Ireland) but data reported in England relate to self‐selected services and are not based on systematic audit of consecutive FH referrals. There are no quality standards for any other services provided by lipid clinics such as management of mixed hyperlipidaemia or statin intolerance.…”

Section: Discussionmentioning

confidence: 99%

Review of referral criteria to lipid clinics and outcomes of treatment in four UK centres

Wierzbicki

Viljoen

et al. 2018

Int J Clin Pract

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Summary Background Little data exist on the referral patterns and effectiveness of lipid clinics. Methods An audit was conducted in four clinics of 100 consecutive referrals each. Data were recorded on referral criteria, cardiovascular disease (CVD) risk factors, drug history, investigations, diagnoses, therapies, results and referrals. Results Patients were aged 56 ± 14 years, 47% were male and 87% were primary prevention. Risk factors included smoking (16%), type 2 diabetes (13%) and hypertension (13%). Referrals were made for hypercholesterolaemia (68%), diagnosis of FH (31%), statin intolerance (23%) and hypertriglyceridaemia (23%). Initial total cholesterol (TC) was 7.65 ± 2.64 mmol/L, triglycerides (TG) 2.17 (0.41‐76.9 mmol/L) mmol/L, HDL‐C 1.53 ± 0.71 mmol/L, LDL‐C 4.57 ± 1.66 mmol/L with non‐HDL‐C 5.90 ± 2.09 mmol/L. Criteria for FH were met in 21% with genetic testing in 13% and lipid cascade testing in 30% of index cases. Triglycerides >20 mmol/L were present in 4%. The diagnosis was changed in 21%: hypercholesterolaemia (7%), mixed hyperlipidaemia (7%) and hypertriglyceridaemia (7%). Hepatic steatosis was identified in 14.5%. Lipoprotein(a) levels >125 nmol/L occurred in 41% in one clinic. Therapy changes included altered statins (40%), addition of a fibrate (11%) or ezetimibe (8%). These reduced TC by 1.92 mmol/L (19%; P = 0.0001), LDL‐C 1.07 mmol/L (15%; P = 0.02), non‐HDL‐C 1.50 mmol/L (16%; P < 0.001), and TG 2.3 (−4 to 38) mmol/L (16%; P < 0.001) with 11% extra achieving TG <5 mmol/L while HDL‐C increased by 7% (P = 0.37). Conclusions Lipid clinics have diverse functions including diagnosis of FH, managing severe hypercholesterolaemia, mixed hyperlipidaemia and statin intolerance. Effectiveness criteria of average reductions of 1.5 mmol/L in TC or non‐HDL‐C, 1 mmol/L in LDL‐C and 2 mmol/L in TG would be reasonable for newly referred patients.

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“…Studies suggest that cyclosporine is a stronger CYP3A4 inhibitor compared to tacrolimus and mTORi 131 . Several small studies have studied the effects of statin therapy in pediatric kidney transplants and have overall found comparable reduction in lipid parameters to adult studies without significant serious adverse effects 132‐136 . None of these studies evaluated the effect of lipid lowering on intermediate end‐points or long‐term cardiovascular outcomes.…”

Section: Dyslipidemiamentioning

confidence: 99%

Promoting cardiovascular health post‐transplant through early diagnosis and adequate management of hypertension and dyslipidemia

Charnaya

Seifert

2020

Pediatric Transplantation

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Despite correction of underlying solid organ failure by transplantation, pediatric transplant recipients still have increased mortality rates compared to the general pediatric population, in part due to increased cardiovascular risk. In particular, pediatric kidney and non‐kidney transplant recipients with chronic kidney disease have significant cardiovascular risk that worsens with declining kidney function. Biomarkers associated with future cardiovascular risk such as casual and ambulatory hypertension, dyslipidemia, vascular stiffness and calcification, and left ventricular hypertrophy can be detected throughout the post‐transplant period and in patients with stable kidney function. Among these, hypertension and dyslipidemia are two potentially modifiable cardiovascular risk factors that are highly prevalent in kidney and non‐kidney pediatric transplant recipients. Standardized approaches to appropriate BP measurement and lipid monitoring are needed to detect and address these risk factors in a timely fashion. To achieve sustained improvement in cardiovascular health, clinicians should partner with patients and their caregivers to address these and other risk factors with a combined approach that integrates pharmacologic with non‐pharmacologic approaches. This review outlines the scope and impact of hypertension and dyslipidemia in pediatric transplant recipients, with a particular focus on pediatric kidney transplantation given the high burden of chronic kidney disease‐associated cardiovascular risk. We also review the current published guidelines for monitoring and managing abnormalities in blood pressure and lipids, highlighting the important role of therapeutic lifestyle changes in concert with antihypertensive and lipid‐lowering medications.

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Statin Use in Australian Children: A Retrospective Audit of Four Pediatric Hospitals

Cited by 8 publications

References 25 publications

Effectiveness and Safety of Statin Therapy in Children: A Real-World Clinical Practice Experience

Effectiveness and Safety of Statin Therapy in Children: A Real-World Clinical Practice Experience

Review of referral criteria to lipid clinics and outcomes of treatment in four UK centres

Promoting cardiovascular health post‐transplant through early diagnosis and adequate management of hypertension and dyslipidemia

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