Be aware of the role of STATINS in children

Overview

As a clinical pharmacist, you should be familiar with the Role of statins in children. More children will be screened and treated for dyslipidemia, now that Canadian and american guidelines suggest expanded screening. About 1 in 300 children are born with familial hypercholesterolemia (FH), which can lead to heart disease, stroke, and early death in adulthood if not treated. But up to 60% of these kids remain undiagnosed if only those with a family history of dyslipidemia or premature cardiovascular (CV) disease are screened.

Management approach

Screening

Now experts recommend to start screening ALL children between age 2 and 10 years to identify more kids with familial hypercholesterolemia (FH), and to spur healthier lifestyle choices. But screening all young children isn’t always practical, and there aren’t robust data yet to support universal screening. Suggest ways to help make screening more practical if possible, such as adding a lipid panel to already planned blood work.

Treatment

For most kids, stick with lifestyle changes first, healthy diet, physical activity, and weight management. Encourage eating foods high in plant sterols (nuts, legumes, vegetable oils, etc) or taking up to 2 g/day of an oral plant sterol supplement (New Roots Plant Sterols, etc).

• Also consider suggesting 6 to 12 g/day of a psyllium supplement (Metamucil, etc) in divided doses, to lower LDL cholesterol by about 10%.
• Counsel to mix the powder with a full glass of water, to prevent choking. But keep in mind there’s no proof plant sterols or psyllium supplements prevent CV disease.
• Recommend saving statins for kids over age 8 with suspected FH, such as those with an LDL above 190 mg/dL (4.9 mmol/L) or with an LDL above 130 mg/dL (3.4 mmol/L) plus risk factors (diabetes, family history of dyslipidemia, etc).
• Suggest starting with the lowest statin dose, such as atorvastatin (Ator, Lipitor, etc) 10 mg daily or rosuvastatin (Crestor, etc) 5 mg to 10 mg daily.

Advise parents that the goal is an LDL cholesterol below 130 mg/dL (3.4 mmol/L) or below 100 mg/dL (2.6mmol/L) for kids with high-risk conditions (severe obesity, etc, .but the target isn’t well defined in kids. Explain that statin side effects (muscle symptoms, etc) in kids with FH seem similar to adults, over about 20 years of use. But it’s too soon to say about the risk of diabetes with longer-term use. Get our notes "Diet for Dyslipidemia" AND "Focus on DIET and exercise for high triglycerides" for more information.

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References

1. Khoury M, Bigras JL, et al. The Detection, Evaluation, and Management of Dyslipidemia in Children and Adolescents: A Canadian Cardiovascular Society/Canadian Pediatric Cardiology Association Clinical Practice Update. Can J Cardiol. 2022 Aug;38(8):1168-1179.
2. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents; National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics. 2011 Dec;128 Suppl 5(Suppl 5):S213-56.

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