The use of statins in childhood

Numerous studies have demonstrated the remarkable efficacy and safety of statins for the prevention of cardiovascular disease in high-risk adults. Currently statins are the most widely prescribed drug in the United States. Statins have been studied in randomized controlled trials in adolescents with severe Familial Hypercholesterolemia and short-term studies verify that they are effective at lowering LDL cholesterol and improve surrogate markers of atherosclerosis. They appear safe over the short term. Interest is growing in their use in adolescents at high risk of future cardiovascular disease however many questions remain unanswered regarding their use, including the optimal timing of their introduction, the safety of their long-term use and whether we should prescribe low does statins or escalate doses to achieve a target level of LDL-cholesterol. The purpose of the paper is to review what is known about statins and to highlight particular areas of uncertainty with respect to their use that I believe are often under appreciated and nonetheless important for pediatricians to know.