Safety and efficacy of treatment of children and adolescents with elevated low density lipoprotein levels with a step two diet or with lovastatin.

The risk factor precursors of arteriosclerotic cardiovascular disease (ASCVD) are expressed in children and adolescents and development of coronary atherosclerosis in adulthood. Certain pediatric subjects have inherited disorders such as familial hypercholesterolemia (FH), familial combined hyperlipidemia, hyperapobetalipoproteinemia, and the metabolic syndrome, which often lead to more marked elevations in plasma low-density lipoprotein (LDL) levels, placing them at increased risk of premature ASCVD. The aim of this report was to examine available data on the safety and efficacy of treatment of children and adolescents with elevated LDL-cholesterol (LDL-C). Treatment of adolescents with elevated LDL-C levels of 130 mg/dL, randomized to an intervention group receiving a stricter Step Two diet, produced a significantly greater fall in LDL-C than those randomized to the usual care group after three years of follow-up in the Dietary Intervention Study in Children (DISC). There were no differences between the intervention and usual care groups in growth and development after either 3 or 7 years of follow-up. In the Lovastatin in Adolescent Males Study (LAMS), 132 boys aged 10 to 17 years with heterozygous FH were randomized into a placebo group or a group receiving up to 40 mg/day of lovastatin. The treatment group had up to a 27% reduction in LDL-C, compared with the placebo group and there were no differences in growth, sexual maturation, hormone or biochemical levels. Longer-term studies are required to assess further the safety of such treatments, and whether treatment will delay the early expression of atherosclerosis such as intima media thickness and endothelial dysfunction.