title: Efficacy and safety of atorvastatin after pediatric heart transplantation.
abstract: BACKGROUND
  Lipid abnormalities are prevalent after pediatric and adult heart transplantation. 3-Hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors are efficacious and safe and can lower the incidence of graft coronary artery disease after heart transplantation in adults. Given the high prevalence of lipid abnormalities and the increased recognition of graft coronary disease in children, we retrospectively investigated the efficacy and safety of atorvastatin among pediatric heart transplant recipients.
  
  
  METHODS
  Thirty-eight patients were started on atorvastatin 48.2 +/- 54.4 months after transplantation. Atorvastatin dosage was 0.2 +/- 0.1 mg/kg per day. No patient had changes in drug dose unless there was evidence for rhabdomyolysis, myositis or an asymptomatic rise in creatine kinase above normal. Laboratory studies included total cholesterol, triglycerides; high, low and very low-density lipoproteins (HDL, LDL and VLDL, respectively); creatine kinase; creatine; and serum alanine transaminase.
  
  
  RESULTS
  Significant declines in total cholesterol (20%), triglyceride (18%) and LDL (26%) were observed after starting atorvastatin therapy. There were no significant changes in HDL or VLDL compared with baseline. There were also no differences in alanine transaminase pre- vs post-atorvastatin therapy. Complications included muscle pain (n = 2) and asymptomatic elevations in creatine kinase (n = 2). Two of these 4 patients developed rhabdomyolysis. Excluding these 4 patients, creatine kinase did not rise compared with baseline. No patient developed alterations in renal function.
  
  
  CONCLUSIONS
  Use of atorvastatin in pediatric heart transplant recipients is effective in lowering total cholesterol, triglyceride and LDL without altering HDL levels. Complications included rhabdomyolysis, seen in 5%. Baseline and routine screening of creatine kinase should be employed in all pediatric patients undergoing HMG-CoA reductase inhibitor therapy.
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California 94304, USA.
authors.forename: Clifford
authors.initials: C
authors.lastname: Chin
authors.forename: Pat
authors.initials: P
authors.lastname: Gamberg
authors.forename: Joan
authors.initials: J
authors.lastname: Miller
authors.forename: Helen
authors.initials: H
authors.lastname: Luikart
authors.forename: Daniel
authors.initials: D
authors.lastname: Bernstein
mesh_terms: D000293:Adolescent; D000069059:Atorvastatin; D002648:Child; D005260:Female; D016027:Heart Transplantation; D006538:Heptanoic Acids / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D008074:Lipoproteins / Q000097:blood; D008297:Male; D011184:Postoperative Period; D011758:Pyrroles / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D012206:Rhabdomyolysis / Q000139:chemically induced
chemical_list: D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008074:Lipoproteins; D011758:Pyrroles; D000069059:Atorvastatin