Gidding - Figure 14 - Treatment rationale
In summary, the treatment rationale includes:
- begin treatment above age 8-10 years in anybody with serum LDL cholesterol
>190 mg/dL or >160 mg/dL after diet intervention (or consider treatment at >160
mg/dL if there are multiple risk factors present);
- clinical trials of statin therapy with medium-term follow-up suggest that both
safety and efficacy are optimal with this therapy, although long-term data and
studies are still lacking;
- a goal for young FH patients is to try to achieve a 50% reduction, or an LDL
level <130 mg/dL.
One important difference between pediatric and adult treatment is the need to assess
the balance between increased dosing and the potential for long-term side effects over
many years. We know that statins do not have a direct linear response in terms of LDL
lowering, so there is a lot of lowering with a small dose of statin, but the dose increases
the percent lowering goes down. Therefore it is necessary to ask the question:
- Is it worth trying to get to a target goal but to have to double or quadruple the
statin exposure for decades of life?
- Or, at a very early stage of atherosclerosis development, simply go for the 50%
lowering with intensification of treatment at later ages.
Gidding S.
J Clin Lipidol.
2011; 5(6).
