The role of statin therapy in children

Atherosclerosis is a disease that begins in childhood. Evidence of fatty streaks, the earliest precursor of atherosclerotic lesions, has been found in the coronary arteries of children as young as two years of age. Hypercholesterolemia is a risk factor for coronary artery disease. Hypercholesterolemia can be either primary, when it is characteristic of the main disease, or secondary when it occurs as a result of either a disease process or drug treatment. Given the risk of vascular disease, including myocardial infarction (MI), cerebrovascular accidents (CVA, also known as strokes), peripheral vascular disease (PVD), and ruptured aortic aneurysm, any or all of which may follow atherosclerosis, it is important to prevent or slow the early development of atherosclerotic lesions. This prevention necessitates the control of key risk factors such hypercholesterolemia, dyslipidemia, hypertension etc. However, at what point this prevention ought to occur, and in what form, is uncertain. This uncertainty stems from the fact that using pharmacological primary prevention in the paediatric population is controversial. In an adult patient the course of action is clear. Hypercholesterolemia warrants the initiation of a statin. Statins, also known as hydroxymethylglutaryl Co-enzyme A inhibitors (or HMG-CoA inhibitors) act by altering cholesterol metabolism. In considering the paediatric population, the clinical course of vascular disease and the effect of altering this clinical course,are less certain. Questions of safety, efficacy and ethics abound.The use of statins in the paediatric population will be examined in this chapter..