Statin Treatment in Children and Adolescents with Elevated LDL-c in Patient with Normoglycaemia and Dysglycaemia

Radwa Helal; Tomader Ali; Rayan Khaled; Nader Lessan

doi:10.1530/endoabs.90.EP375

Background: The obesity prevalence surge in children and adolescents is associated with dysglycaemia, dyslipidaemia and long-term cardiovascular complications. Use of lipid-lowering medications¹ has been recommended following lifestyle modifications. We aim to investigate the demographic, and changes in LDL-c, in these young patients, in the presence and absence of dysglycaemia.

Methods: Complete lipid profiles of patients (≤19 years old) with hyperlipidaemia who are prescribed statin therapy was extracted based on International Classification of Diseases (ICD) Codes (n=150). Patients with familial hypercholesterolemia (n=20), or prescribed Omega-3 supplements (n=61), were excluded. The remaining patients (n=69) were further sub-grouped per sex and diabetes status. Median (IQR) LDL-c levels were calculated with Wilcoxon matched-pairs signed rank test for Pre- and Post-statin therapy (6 months) initiation was analysed using GraphPad PRISM 9 with statistical significance set at the ≤0.05 level.

Results: Within the study population (n=69 patients) receiving statin therapy (females=51.43%), mean age was 15.97±3.02 years (minimum=6 years; maximum=19 years). Sub-grouped per diabetes status; normoglycaemic (NGT; n=15 [21.7%]), Pre-Diabetes (Pre-Dia; n=10 [14.5%]), type 1 diabetes (T1DM; n=33 [47.8%]), type 2 diabetes (T2DM; n=8 [11.6%]), MODY (n=2, 3.0%) and secondary diabetes (n=1; 1.4%). Median (IQR) LDL-c levels for all patient groups significantly decreased compared to baseline; P-value 0.01 - <0.0001.

Table 1 LDL-c changes in children and adolescents with hyperlipidaemia
LDL-c Level (mmol/l)	Patient Groups	Pre-statin therapy	Post-statin therapy (6 months)	Change in Statin (ΔLDL-c mmol/l)	P-value
	All Patients	4.60 (3.92, 5.19)	3.52 (3.00, 4.42)	1.08	<0.0001
	NGT	5.00 (4.11, 546)	4.00 (3.22, 5.00)	1.00	0.001
	Pre-Dia	4.57 (3.96, 4.96)	3.88 (2.94, 4.67)	0.69	0.002
	All NGT + Pre-Dia	4.84 (4.08, 5.18)	4.00 (3.22, 4.99)	0.84	<0.0001
	T1DM	4.56 (3.85, 5.53)	3.36 (2.99, 4.43)	1.20	<0.0001
	T2DM	3.89 (3.38, 4.71)	3.53 (2.14, 422)	0.36	0.008
	All Dia	4.46 (3.72, 5.30)	3.38 (2.95, 422)	1.08	<0.0001

Conclusion: All patients receiving statin therapy, independent of their diabetes status, showed a significant decrease in LDL-c levels post-statin therapy. Data further highlights the importance of identifying young patients where lifestyle modifications alone is not effective particularly in the presence of obesity and/or diabetes. This indicates that early detection, diagnosis, and timely intervention in management of dyslipidemia, is cornerstone in avoiding long-term cardiovascular disease in young patients. Patients (n= 61) were assessed Pre- and Post-lipid lowering (statin) therapy. Median (IQR) LDL-c levels were calculated with statistical significance (≤0.05 level).

Reference: 1. Miller, M.L., C.C. Wright, and B. Browne, Lipid-lowering medications for children and adolescents. J Clin Lipidol, 2015. 9 (5 Suppl): p. S67-76.

Endocrine Abstracts

EP375