Correlates of Achieving Statin Therapy Goals in Children and Adolescents with Dyslipidemia

• Published in: The Journal of pediatrics Vol. 178; pp. 149 - 155.e9
• Main Authors: Mendelson, Michael M., MD, ScM, Regh, Todd, MStat, Chan, James, MSc, Baker, Annette, NP, Ryan, Heather Harker, RN, Palumbo, Nicole, NP, Johnson, Philip K., BSc, Griggs, Suzanne, RD, Boghani, Meera, RD, Desai, Nirav K., MD, Yellen, Elizabeth, MD, Buckley, Lucy, MD, Gillman, Matthew W., MD, SM, Zachariah, Justin P., MD, MPH, Graham, Dionne, PhD, de Ferranti, Sarah D., MD, MPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2016
• Subjects: Adolescent; Boston; Child; Cholesterol, LDL - blood; dyslipidemia; Dyslipidemias - drug therapy; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; low-density lipoprotein cholesterol; Male; Pediatrics; Proportional Hazards Models; Prospective Studies; Risk Factors; statins; Standardized Clinical Assessment and Management Program; FH; Quality improvement; LDL-C; SCAMP; low-density lipoprotein cholesterol; CK; ALT; Cardiovascular disease; Creatinine kinase; HR; Upper limit of normal; Hazard ratio; CVD; NHLBI; statins; ULN; pediatrics; QI; Familial hypercholesterolemia; dyslipidemia; US National Heart, Lung, and Blood Institute; Alanine transferase
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2016.08.003

Objective To determine the real-world effectiveness of statins and impact of baseline factors on low-density lipoprotein cholesterol (LDL-C) reduction among children and adolescents. Study design We analyzed data prospectively collected from a quality improvement initiative in the Boston Children's Hospital Preventive Cardiology Program. We included patients ≤21 years of age initiated on statins between September 2010 and March 2014. The primary outcome was first achieving goal LDL-C, defined as <130 mg/dL, or <100 mg/dL with high-level risk factors (eg, diabetes, etc). Cox proportional hazards models were used to assess the impact of baseline clinical and lifestyle factors. Results Among the 1521 pediatric patients evaluated in 3813 clinical encounters over 3.5 years, 97 patients (6.3%) were started on statin therapy and had follow-up data (median age 14 [IQR 7] years, 54% were female, and 24% obese, 62% with at least one lifestyle risk factor). The median baseline LDL-C was 215 (IQR 78) mg/dL, and median follow-up after starting statin was 1 (IQR 1.3) year. The cumulative probability of achieving LDL-C goal within 1 year was 60% (95% CI 47-69). A lower probability of achieving LDL-C goals was associated with male sex (HR 0.5 [95% CI 0.3-0.8]) and higher baseline LDL-C (HR 0.92 [95% CI 0.87-0.98] per 10 mg/dL), but not age, body mass index percentile, lifestyle factors, or family history. Conclusions The majority of pediatric patients started on statins reached LDL-C treatment goals within 1 year. Male patients and those with greater baseline LDL-C were less likely to be successful and may require increased support.