Published online February 1, 2007
PEDIATRICS Vol. 119 No. 2 February 2007, pp. 370-380 (doi:10.1542/peds.2006-0787)
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SPECIAL ARTICLE

The Use of Statins in Pediatrics: Knowledge Base, Limitations, and Future Directions

Brook Belay, MDa, Peter F. Belamarich, MDb and Catherine Tom-Revzon, BS, PharmDc,d

a Department of Pediatrics, Temple University Children's Medical Center, Temple University School of Medicine, Philadelphia, Pennsylvania
b Department of Pediatrics, Children's Hospital at Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
c Division of Pharmacy Practice, Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, New York
d Department of Pharmacy, Children's Hospital at Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York

The 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, or statins, effectively reduce coronary morbidity and mortality in high-risk adults. They are also some of the most widely prescribed medications in the United States. Their use in pediatrics, however, remains circumscribed. In this article we review the cholesterol hypothesis and focus on the knowledge base of the use of statins in adults and children. We pay particular attention to the known effects of statins in primary and secondary prevention of cardiovascular events. The toxicities of statins and their limitations in pediatrics are then considered. The use of statins in conjunction with noninvasive modalities of assessing atherosclerotic burden are also reviewed. Finally, we suggest methods to advance the use of statins in childhood that introduce their potential benefits to those individuals at highest risk for future events.

Key Words: statins • pediatrics • indications • limitations

Abbreviations: HMG-CoA—3-hydroxy-3-methyl-glutaryl coenzyme A • heFH—heterozygous familial hypercholesterolemia • CVD—cardiovascular disease • LDL-C—low-density lipoprotein cholesterol • FDA—Food and Drug Administration • CVE—cardiovascular event • CRP—C-reactive protein • BAS—bile-acid sequestrant • EBCT—electron-beam computed tomography • FMD—flow-mediated dilation of the brachial artery • cIMT—carotid intima-media thickness

Accepted Oct 4, 2006.


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