| Are treatment targets for hypercholesterolemia evidence based? Systematic review and meta-analysis of randomised controlled trials. | |
| | |
MedLine Citation:
|
PMID: 20515970 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
OBJECTIVE: Search for evidence supporting target age, level of intervention and target values for low-density lipoprotein (LDL) cholesterol levels in children with familial hypercholesterolemia. DESIGN: Systematic review and meta-analysis. PubMed, Medline, CINAHL and Cochrane Reviews databases from 1966 to 2007 were searched for articles reporting statin therapy in children and adolescents aged 8-18 years. Retrieved articles were screened for double-blind randomised controlled trials (RCTs). RESULTS: Seven trials involving 884 patients met inclusion criteria. Meta-analysis findings showed significantly reduced total cholesterol, LDL cholesterol and apolipoprotein B, whereas high-density lipoprotein cholesterol and apolipoprotein A1 were significantly increased by statin therapy. Evidence on target level in children was limited to one study attainment of LDL cholesterol treatment target in 60% of the subjects in the treatment group and none in the placebo group reached their target LDL cholesterol. Evidence on the effect of statins on surrogate markers of atherosclerosis was limited to two studies (one RCT on the effect upon the carotid intima-media thickness (n=211; mean difference (MD) -0.01; 95% CI -0.03 to -0.00), and one showing that the mean absolute change in flow-mediated dilation after 28 weeks of statin treatment was significantly higher in the simvastatin group compared to placebo group (MD 2.7%; 95% CI 0.42 to 4.98). CONCLUSIONS: There is no firm evidence regarding when to start statin treatment or what target LDL cholesterol level should be attained. Recent recommendations that favour statins as the first-line drug treatment for hypercholesterolemia are evidence based. Studying high-risk groups (obese or diabetic patients) and incorporating composite end points may help define treatment guidelines. |
| | |
Authors:
|
Y Lebenthal; A Horvath; P Dziechciarz; H Szajewska; R Shamir |
Publication Detail:
|
Type: Journal Article; Meta-Analysis; Review Date: 2010-06-01 |
Journal Detail:
|
Title: Archives of disease in childhood Volume: 95 ISSN: 1468-2044 ISO Abbreviation: Arch. Dis. Child. Publication Date: 2010 Sep |
Date Detail:
|
Created Date: 2010-08-18 Completed Date: 2010-10-21 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 0372434 Medline TA: Arch Dis Child Country: England |
Other Details:
|
Languages: eng Pagination: 673-80 Citation Subset: AIM; IM |
Affiliation:
|
The Combined Lipid Clinic, Schneider Children's Medical Center, Petah Tikva, Israel. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adolescent Apolipoproteins / blood Child Cholesterol / blood Cholesterol, HDL / blood Cholesterol, LDL / blood Evidence-Based Medicine Female Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects, therapeutic use* Hypercholesterolemia / blood, drug therapy* Male Randomized Controlled Trials as Topic |
| Chemical | |
Reg. No./Substance:
|
0/Apolipoproteins; 0/Cholesterol, HDL; 0/Cholesterol, LDL; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors; 57-88-5/Cholesterol |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Enhanced surveillance of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia in children ...
Next Document: UK incidence of achalasia: an 11-year national epidemiological study.