ABC | Volume 112, Nº3, March 2019

Letter to the Editor Do Not Treat Children with Statins David M. Diamond, 1 U ffe Ravnskov, 2 Michel de Lorgeril 3 University of South Florida, Psychology, Molecular Pharmacology & Physiology, 1 Tampa, Florida – USA Independent investigator, 2 Lund - Sweden School of Medicine, University of Grenoble-Alpes, Laboratoire Coeur et Nutrition, TIMC-IMAG, 3 Grenoble – France Mailing Address: David M. Diamond, Ph.D. • Department of Psychology, PCD 4118G, University of South Florida, Tampa, 33620 FL, USA E-mail: ddiamond@usf.edu Manuscript received November 24, 2018, revised manuscript January 23, 2019, accepted January 23, 2019 Keywords Statins; Hydroxymethylglutaryl CoA Reductase; Inhibitors; Hypercholesterolemia Type II/genetics; Children; Meta-analysis. 1. Radaelli G, SausenG, Cesa CC, Santos FS, Portal VLNeyeloff JL, Pellanda LC. Statintreatmentsanddosages inchildrenwith familialhypercholesterolemia: Meta-analysis. Arq Bras Cardiol. 2018;111(6):810-21. 2. Ravnskov U, de Lorgeril M, Kendrick M, Diamond DM. Inborn coagulation factors are more important cardiovascular risk factors than high LDL- cholesterol in familial hypercholesterolemia. Med Hypotheses. 2018;121:60-3. 3. DiamondDM,RavnskovU.Howstatisticaldeceptioncreatedtheappearance that statins are safe and effective in primary and secondary prevention of cardiovascular disease. Expert Rev Clin Pharmacol. 2015;8(2):201–10. 4. Ravnskov U, de Lorgeril M, Diamond DM, Hama R, Hamazaki T, Hammarskjöld B et al. LDL-C does not cause cardiovascular disease: a comprehensive review of current literature. Expert Rev Clin Pharmacol. 2018;11(10):959-70. References Reply We thank Ravnskov et al. 1 for the letter, which enables the discussion of a relevant issue and concern in clinical practice for the treatment of children and adolescents with dyslipidemia, especially in long term. The reason for the development of our meta-analysis was based on the use of statins to treat children with secondary dyslipidemia which, to our understanding, is not based on solid evidence. This was the main objective of our meta-analysis, i.e ., to identify supporting evidence for this practice, rather than to conduct a review of studies on children with familial hypercholesterolemia. We searched for evidence for treatment of children with statins on PubMed, EMBASE, Bireme, Web of Science, Cochrane Library, SciELO and LILACS databases from inception to February 2016. Of a total of 16,793 potentially relevant citations retrieved from the electronic databases, no randomized clinical trial met the inclusion criteria. 1 Although we cited studies on familial hypercholesterolemia in the discussion section, we neither reviewed these studies, nor produced any clinical recommendations for this condition. Our only comment to the letter is the fact, the discussion section of our meta-analysis may have been misinterpreted, as it does not support a recommendation for clinical practice and was not written with such intention. We are thankful for the opportunity to make this clear. 2 DOI: 10.5935/abc.20190034 In their meta-analysis Radaelli et al. conclude that statin treatment is efficient in lowering lipids in children with familial hypercholesterolemia (FH) and suggest that long-term trials should be performed to establish long-term safety. 1 We would warn against their recommendation for several reasons. As we have shown in a recent paper, 2 there is much evidence that high LDL-cholesterol (LDL-C) is not the cause of premature coronary heart disease in FH; it is most likely inborn abnormal coagulation factors, and only a small minority among those with FH inherits these factors. On average, people with FH live just as long as other people because high LDL-C protects against cancer and infectious diseases. 2 Furthermore, to treat children with statins may ultimately cause them harm because cholesterol is necessary for the developing brain and is an essential precursor for metabolic co-factors and hormones, including vitamin D and all sex steroids. Finally, it is becoming well-known that the number of adverse effects from statin treatment is much larger and much more serious than reported in the trial reports. 3,4 Hence, there is justifiable concern that long-term treatment of children with FH will cause them more harm than benefit. 324