ABC | Volume 111, Nº3, September 2018

Original Article Secondary Dyslipidemia In Obese Children – Is There Evidence For Pharmacological Treatment? Graciane Radaelli, Grasiele Sausen, Claudia Ciceri Cesa, Vera Lucia Portal, Lucia Campos Pellanda Instituto de Cardiologia / Fundação Universitária de Cardiologia – IC/FUC, Porto Alegre, RS - Brazil Mailing Address: Lucia Campos Pellanda • Av. Princesa Isabel, 370, 3º andar, Postal Code 99620-000, Santana, Porto Alegre, RS – Brazil E-mail: pellanda.pesquisa@gmail.com, metodologia.up@cardiologia.org.br Manuscript received February 08, 2017, revised mansucript June 21, 2017, accepted September 01, 2017 DOI: 10.5935/abc.20180155 Abstract Background: Long-term safety, effectiveness and criteria for treatment with statins in children are still unclear in clinical practice. There is very limited evidence for the use of medication to treat children with dyslipidemia secondary to obesity who do not respond well to lifestyle modification. Objective: Systematic review of randomized clinical trials of statin use to treat children and adolescents with dyslipidemia secondary to obesity. Methods: We performed a search in PubMed, EMBASE, Bireme, Web of Science, Cochrane Library, SciELO, and LILACS for data to evaluate the effect of statins on: improvement of surrogate markers of coronary artery disease in clinical outcomes of adulthood; increased serum levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and apolipropotein B (APOB); and decreased serum levels of high-density lipoprotein cholesterol (HDL-C) from inception to February 2016. Participants were children and adolescents. Results: Of the 16793 potentially relevant citations recovered from the electronic databases, no randomized clinical trials fulfilled the inclusion criteria for children with dyslipidemia secondary to obesity. Conclusions: We found no specific evidence to consider statins in the treatment of hypercholesterolemia secondary to obesity in children. The usual practice of extrapolating findings from studies in genetic dyslipidemia ignores the differences in long-term cardiovascular risks and the long-term drug treatment risks, when compared to recommendation of lifestyle changes. Randomized clinical trials are needed to understand drug treatment in dyslipidemia secondary to obesity. (Arq Bras Cardiol. 2018; 111(3):356-361) Keywords: Dyslipidemias; Child; Obesity; Adolescents; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Cholesterol. Introduction According to the National Survey on Health and Nutrition Examination, 11.7% of adults aged 20-39 years and 41.2% of adults aged 40-64 years had elevated low- density lipoprotein cholesterol (LDL-C) levels. 1 Recent data shows that the estimated number of adults who have total cholesterol (TC) levels ≥ 240 mg/dL reaches 30.9 million and 32.6% of the adults have hypertension. 2 In 2011-2012, of 5 boys and girls, 1 had abnormal concentration of TC, high-density lipoprotein cholesterol (HDL-C) or non-high density lipoprotein cholesterol (non-HDL-C). The prevalence of high TC, HDL-C, non-HDL-C is 7.8%, 12.8% and 8.4%, respectively, and 20.2% had abnormal concentration of at least 1 of the 3 measurements. 3 Dyslipidemia causes have changed in epidemiological studies; previously, genetic disturbances were the most common conditions causing dyslipidemia in children. In the last few decades, dyslipidemia secondary to obesity (DSO) has been increasing. 4 Drug therapy for high-risk lipid abnormalities resulted in great advances in the prevention and treatment of atherosclerotic diseases in adults. 5 However, the use of pharmacological therapy in children with secondary dyslipidemia is a subject of controversy. Safety, effectiveness and criteria for statin treatment in children are unclear in clinical practice. 6 There is limited evidence for medication use in children with DSO that do not respond well to lifestyle modification. The majority of studies with statins refer to children and adolescents with genetic dyslipidemia and higher levels of LDL-C. The objective of this study is to discuss critically the evidence about the effectiveness, safety and effects of the use of statins in children and adolescents with DSO, based on a systematic review of the literature. Methods This systematic review was performed in accordance with the PRISMA Statement and registered at the PROSPERO under identification CRD42015020530. The search was conducted in MEDLINE (via PubMed), EMBASE, Bireme, Web of Science, Cochrane Library, SciELO, 356