Use of statins at very young age

[pp123]

Hallo, maybe I should not be writing here but I need more opinions on prescribing statins to a child at age 5. We have a family heredity of high cholesterol level (my mother, both my sisters an myself and now my son). My son was firts tested at age three when I told the pediatrician that we have a family hypercholesterolemia. At the age of 5 we went to endocrinologist where they took some ekstra tests. He had LDL=7,7mmol/L, HDL=1,2 mmol/l, S-triglicerid= 0,8 mmol/L I will not write all others even some are probably important. Diets were no option because we already eat very healthy because I live with this disease for more then 20 years and the boy is tiny and skiny. He was prescribed Questran. We are taking it for 5 months and the test after 3-4 months of taking Questran are LDL=4,1 mmol/L, HDL=1,2 mmol/L, S-triglicerid=0,4 mmol/L. I know that results are fantastic because my mother with taking the best medicine ever for 20 years never get LDL under 7 mmol/L but I'm still warried. Because I think that he still needs fat, vitamins, Q10... for growth and development of body and brain. And a question if he has to take medicine is Questran really the best drug?
thanks, pp123

 

[Frame Dragger]

This is not a place to get specific medical advise, as no diagnoses can be reliably made in this context. In general, I would be very leery of a treatment that has proven that it can have devastating adverse reactions. Beyond that I don't feel comfortable making a specific recommendation.

 

[SW VandeCarr]

Statins have been studied in children as young as 8 for familial hypercholesterolemia (FH), but their use remains controversial. The American Academy of Pediatrics (AAP) included the use of statins in its updated (2008) guidelines for FH in children. As far as I know, there are no published studies in children as young as 5. In any case, you need to follow the recommendations of a qualified pediatrician. There can be severe side effects with the use of statins.

http://content.nejm.org/cgi/content/full/359/13/1309

 

[IcedEcliptic]

You say he is already on the Statin, and muscle pain and other adverse reactions would already manifest. Track the liver for health, and remember that Statins have risks, but so does congenital heart disease. This is a matter for a skilled pediatrician, and nothing online I think.

 

[SW VandeCarr]

You say he is already on the Statin, and muscle pain and other adverse reactions would already manifest. Track the liver for health, and remember that Statins have risks, but so does congenital heart disease. This is a matter for a skilled pediatrician, and nothing online I think.

I didn't see where the OP said the child was on a statin. The child is on Questran (cholestyramine) which is a resin. It reduces the absorption of fat from the GI tract by sequestering bile acids. I doubt whether a reputable physician would put a 5 year old on a statin at the present time. There's no data that I know of, and it is outside the AAP guidelines which I linked in my previous post.

EDIT: The best chance of getting non-approved treatment for the child is in an approved clinical trial. A qualified pediatrician can help with this, but it can be difficult. In addition, there is a big developmental difference between 5 year olds and 8 year olds. It's possible your child might qualify by age seven provided he meets the criteria for the particular trial.

 

[pp123]

Thank you all for your replies. Sometimes he does have muscle pain and irritaded eyes, headakes... all side effects. I got scared after a chemist in a drug-store said that this is not a drug that should be used for a longer period and I hope that our specialist endocrynologist choose the best medicine to help him. Together with Questran he needs to take fat-soluble vitamins such as A, D, E, and K, folic acid. In every case we will discuss this with the doctor. I just wanted to be prepared and know if Questran is really the best solution.
Sorry for my English, it is not my native language.
pp123

 

[pp123]

We are in a sort of clinical trial it is all regular in a country that we live in. But I still feel that my son is a test bunny and that they are not sure what would be better - taking a medicine like Questran or not. I'm 38 years old and don't take medicine to lower my cholesterol when I did I had severe muscle pain and stomach pain. My sister is 48 and she never took medicine but she sometimes have blackouts...I hope she would see a doctor soon. My mother is 72 and she's taking medicine for 20 years and they say that she's a phenomenon. But they say it's different for a man that women have some hormon that protects us. I just wan't what is best for my son.

 

[Proton Soup]

tried other things? like exercise? anything to raise insulin sensitivity may just be the ticket.

http://www.jlr.org/cgi/rapidpdf/jlr.P006619v1.pdf

________________________________________

J Lipid Res. 2010 May 1. [Epub ahead of print]
Insulin sensitivity regulates cholesterol metabolism to a greater extent than obesity. Lessons from the METSIM study.

Gylling H, Hallikainen M, Pihlajamaki J, Simonen P, Kuusisto J, Laakso M, Miettinen TA.

University of Eastern Finland, Finland;
Abstract

Cholesterol synthesis is upregulated and absorption downregulated in insulin resistance and in type 2 diabetes. We investigated whether alterations in cholesterol metabolism are observed across the glucose tolerance status, from normoglycemia through impaired glucose tolerance to type 2 diabetes in 781 randomly selected men 45 to 70 years of age from a population-based Metabolic Syndrome in Men (METSIM) study. Cholesterol metabolism was assayed using surrogate serum markers, squalene and non-cholesterol sterols. The study population was classified into subgroups according to glucose tolerance as follows: normoglycemia, impaired fasting glucose, impaired glucose tolerance, and type 2 diabetes. LDL cholesterol did not differ between the groups. Cholesterol synthesis markers were lowest and absorption markers highest in normoglycemia. Sitosterol was lower in subjects with impaired fasting glucose compared to normoglycemic subjects (113+-7 vs. 136+-3 100micromol/mmol of cholesterol, p<0.05). LDL cholesterol was not associated with lathosterol/sitosterol ratio, a marker of cholesterol metabolism. Peripheral insulin sensitivity evaluated by the Matsuda index was associated with the lathosterol/sitosterol ratio in the entire population (r=-0.457, p<0.001), and with that of lathosterol/cholestanol independently of obesity.In conclusion, cholesterol metabolism was altered already in subjects with impaired fasting glucose. Upregulated cholesterol synthesis was associated with peripheral insulin resistance independent of obesity.

PMID: 20436182

 

[pp123]

The boy hyperactive. We will have to train him for later period that he will have regular physical activity but now he doesn't need it.

 

[SW VandeCarr]

Track the liver for health, and remember that Statins have risks, but so does congenital heart disease.

The OP did mention any congenital heart disease, which is the result of a heart defect present at birth (by definition). The risk associated with FH is the premature onset of coronary artery disease and other vascular complications.

 

[SW VandeCarr]

I just wan't what is best for my son.

We cannot comment on diagnosis or treatment here, but I will say that your son seems to have had a good response based on the figures you presented. Questran is effective in FH, but is often not well tolerated in children.

You seem to be in good hands. The next step, if he needs it in a few years, would be a statin, but your son is not candidate for this right now. As long as his LDL cholesterol is controlled, I don't see a need to rush into a stronger medicine anyway. I wish you and your son all the best.

http://www.ncbi.nlm.nih.gov/pubmed/8441109

 

[Moonbear]

I don't have much to contribute to this thread that hasn't already been mentioned. I think that high cholesterol is a rather uncommon diagnosis in such a young child when it is not induced by diet, so it will be difficult to find literature to inform one on the course of treatment. One does need to balance the risks of the treatment against the risks of not treating the condition to determine what is the best course to follow.

So, all I will suggest is that when you have a child with an unusual condition for their age, seek a second opinion from another physician. We are NOT qualified here to second-guess medical opinion online, but if you have the least bit of doubt, it is perfectly reasonable to consult another physician to see if they concur or differ in opinion with the first physician.

 

[Xnn]

Diets were no option because we already eat very healthy because I live with this disease for more then 20 years and ...

pp123;

Unfortunately, the ideal diet for lowering cholesterol is not always well understood.
That high cholesterol sometimes appears to run in families can be a sign of shared
dining habits more so than genetics.

 

[Internist]

pp123;
That high cholesterol sometimes appears to run in families can be a sign of shared
dining habits more so than genetics.

Possibly true, but irrelevant in this case (of familial hypercholesterolemia) where the genetic lesion (absent or non-functional LDL receptors) is well documented.

More generally, the role of diet in lowering cholesterol levels (i.e. LDL cholesterol) has been overstated. For most people, no more than about 25 or 30 percent of their LDL cholesterol is derived from diet; the majority of a person's LDL actually comes from the liver's synthesis of cholesterol. And, the percentage of LDL not arising from the diet increases as the LDL increases. So, those with the highest levels of LDL actually have only a small portion of it due to diet. Bottom line is that on average, "dietary measures" seldom lower cholesterol by more than about 15 percent.

Perhaps this explains why no trial has ever shown that "dietary control" of cholesterol, without concomitant pharmacologic therapy, leads to reduced coronary disease. It may also account for the spectacular failure of http://en.wikipedia.org/wiki/Ezetimibe" .

If it seems anyone is still reading this thread, I'd be pleased to discuss further.

 

[SW VandeCarr]

If it seems anyone is still reading this thread, I'd be pleased to discuss further.

Thanks. The original poster (OP) and I had a question about the use of HMG CoA reductase inhibitors in a 5 year old with heterozygous FH. We can't give specific recommendations in this forum, but the current guidelines only extend to children age 8 and older. I'm not aware of published data on younger children. In this particular case, cholestyramine appears to have had a positive effect (LDL from 7.7 mmol/L to 4.1 mmol/L).

Suppose this was a more severe and unresponsive case. What's your general view of studying statins in children under age 8?

 

[Xnn]

For most people, no more than about 25 or 30 percent of their LDL cholesterol is derived from diet...

If it seems anyone is still reading this thread, I'd be pleased to discuss further.

In the US, the average cholesterol level is about 200 mg/dl.
In China it is about 125 mg/dl.
No trials, but well established thru population studies.


Personally, my levels have dropped just about as much with only diet modification.

 

[SW VandeCarr]

In the US, the average cholesterol level is about 200 mg/dl.
In China it is about 125 mg/dl.
No trials, but well established thru population studies.Personally, my levels have dropped just about as much with only diet modification.

The issue of diet and cholesterol levels is a separate discussion. This thread is about a genetic defect (FH) which causes elevated LDL levels in children and young adults. The OP clearly described her child as "tiny and skinny".

Moreover, if you want to maintain a scientific discussion, you should supply links for your claims.

Here's a link you can use:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1312230/

However, it's not particularly relevant to the current topic.