Radaelli Graciane, Sausen Grasiele, Cesa Claudia Ciceri, Santos Francisco de Souza, Portal Vera Lucia, Neyeloff Jeruza Lavanholi, Pellanda Lucia Campos
Instituto de Cardiologia - Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS - Brazil.
Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS - Brazil.
Arq Bras Cardiol. 2018 Dec;111(6):810-821. doi: 10.5935/abc.20180180. Epub 2018 Oct 18.
Children with familial hypercholesterolemia may develop early endothelial damage leading to a high risk for the development of cardiovascular disease (CVD). Statins have been shown to be effective in lowering LDL cholesterol levels and cardiovascular events in adults. The effect of statin treatment in the pediatric population is not clearly demonstrated.
To systematically review the literature to evaluate the effects of different statins and dosages in total cholesterol levels in children and adolescents with familial hypercholesterolemia. We also aimed to evaluate statin safety in this group.
PubMed, EMBASE, Bireme, Web of Science, Cochrane Library, SciELO and LILACS databases, were searched for articles published from inception until February 2016. Two independent reviewers performed the quality assessment of the included studies. We performed a meta-analysis with random effects and inverse variance, and subgroup analyses were performed.
Ten trials involving a total of 1543 patients met the inclusion criteria. Our study showed reductions in cholesterol levels according to the intensity of statin doses (high, intermediate and low): (-104.61 mg/dl, -67.60 mg/dl, -56.96 mg/dl) and in the low-density lipoprotein cholesterol level: [-105.03 mg/dl (95% CI -115.76, -94.30), I2 19.2%], [-67.85 mg/dl (95% CI -83.36, -52.35), I2 99.8%], [-58.97 mg/dl (95% CI -67.83, -50.11), I2 93.8%. The duration of statin therapy in the studies ranged from 8 to 104 weeks, precluding conclusions about long-term effects.
Statin treatment is efficient in lowering lipids in children with FH. There is need of large, long-term and randomized controlled trials to establish the long-term safety of statins.
家族性高胆固醇血症患儿可能会出现早期内皮损伤，导致发生心血管疾病（CVD）的风险很高。他汀类药物已被证明可有效降低成人的低密度脂蛋白胆固醇水平并减少心血管事件。他汀类药物治疗在儿科人群中的效果尚未得到明确证实。
系统回顾文献，以评估不同他汀类药物及其剂量对家族性高胆固醇血症儿童和青少年总胆固醇水平的影响。我们还旨在评估该组中他汀类药物的安全性。
检索了PubMed、EMBASE、Bireme、科学网、Cochrane图书馆、SciELO和LILACS数据库，以查找从数据库建立至2016年2月发表的文章。两名独立的审阅者对纳入研究进行了质量评估。我们进行了随机效应和逆方差的荟萃分析，并进行了亚组分析。
共有10项试验，涉及1543例患者，符合纳入标准。我们的研究显示，根据他汀类药物剂量强度（高、中、低），胆固醇水平降低幅度分别为：（-104.61mg/dl、-67.60mg/dl、-56.96mg/dl），低密度脂蛋白胆固醇水平降低幅度分别为：[-105.03mg/dl（95%CI -115.76，-94.30），I² 19.2%]，[-67.85mg/dl（95%CI -83.36，-52.35），I² 99.8%]，[-58.97mg/dl（95%CI -67.83，-50.11），I² 93.8%]。研究中他汀类药物治疗的持续时间为8至104周，因此无法得出关于长期效果的结论。
他汀类药物治疗可有效降低家族性高胆固醇血症患儿的血脂水平。需要进行大型、长期和随机对照试验，以确定他汀类药物的长期安全性。
