ABC | Volume 112, Nº3, March 2019

Letter to the Editor Diamond et al Children and statin Arq Bras Cardiol. 2019; 112(3):324-325 1. Radaelli, G., Sausen, G., Cesa, C. C., Portal, V. L., & Pellanda, L. C. (2018). Secondary Dyslipidemia In Obese Children-Is There Evidence For Pharmacological Treatment?. Arq Bras Cardiol. 218;111(3):356-61. 2. Ravnskov U, de Lorgeril M, Kendrick M, Diamond DM. Inborn coagulation factorsaremoreimportantcardiovascularriskfactorsthanhighLDL-cholesterol in familial hypercholesterolemia. MedHypotheses. 2018;121:60-3. References This is an open-access article distributed under the terms of the Creative Commons Attribution License We can affirm that there is not sufficient evidence to treat children with dyslipidemia with statins, even those with familial hypercholesterolemia, particularly regarding the long-term safety of this practice. In our opinion, this is a matter of great concern, since we did not find any long‑term study, or any study describing potential long-term side-effects of early intervention on cholesterol reduction or delay in the appearance of cardiovascular events. In the article, we reported that “children with serious lipid abnormalities due to genetic disorders may meet the criteria for drug therapy with the statins commonly used in adults” (my emphasis). This is not a recommendation and does not exhaust the subject. We reiterate our conclusion that, before prescribing statins to children with secondary dyslipidemia, studies should be performed to determine whether these drugs can reduce overall and long-term morbidity and mortality, which, again, was the main objective of our study. We believe that Ravnskov et al. make important contributions to this issue, by adding recent data about causal mechanisms of familial hypercholesterolemia, and concerns about the risk of long‑term use of statins in this condition. This is corroborated by the studies published in 2018 cited by the authors. Thus, we agree with the authors in suggesting caution in the long-term use of drugs in pediatric patients with chronic conditions. Graciane Radaelli 325