title: Atorvastatin safety in Kawasaki disease patients with coronary artery aneurysms.
abstract: Statins (HMG-CoA reductase inhibitors) may decrease inflammation in postacute Kawasaki disease (KD) complicated by coronary artery aneurysm (CAA) and promote vascular remodeling. There are limited data on their safety in young children. Twenty patients with CAAs after KD (median CAA z-score = +25) were treated with 5/10 mg atorvastatin daily for a median of 2.5 years (range 0.5-6.8) starting at a median of 2.3 years (range 0.3-8.9) after acute KD (median age 9.3 years [range 0.7-14.3]). Compliance with treatment was excellent: only one patient reported minor side effects (joint pain, no change in medication). Average total cholesterol before atorvastatin was 3.73 ± 0.84 mmol/L and after atorvastatin was 3.21 ± 0.46 mmol/L (relative decrease -14 %, p = 0.02); low-density lipoprotein cholesterol was 1.99 ± 0.76 mmol/L before and only 1.49 ± 0.27 mmol/L after (relative decrease -20 %, p = 0.04); high-density lipoprotein was 1.39 ± 0.36 mmol/L before and 1.30 ± 0.27 mmol/L after (relative decrease -4 %, p = 0.35); and triglycerides were 0.71 ± 0.28 mmol/L before and 0.71 ± 0.18 mmol/L after (relative decrease -5 %, p = 0.38). Nine of 20 patients (45 %) experienced at least 1 episode of hypocholesterolemia (total cholesterol <3.1 mmol/L), and 2 patients required atorvastatin dose lowering. Transient mild increase of liver enzymes (aspartate aminotransferase/alanine aminotransferase 45-60 U/L) were seen in 7 of 20 (35 %) patients with no patients experiencing more severe increases. Only one patient experienced increased creatine phosphokinase levels (>500 U/L). Serial measurements of age- and sex-specific percentiles of weight (estimated change: 1.4 [2.7] % per year, p = 0.60), height (estimated change: -3.2 [3.2] % per year, p = 0.32), and body mass index (estimated change: 1.0 [2.9] % per year, p = 0.73) showed no association between anthropomorphic growth and atorvastatin treatment. Atorvastatin use in very young children with KD is safe but should be closely monitored.
authors.affiliation: Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Niedra
authors.forename: Nita
authors.initials: N
authors.lastname: Chahal
authors.forename: Cedric
authors.initials: C
authors.lastname: Manlhiot
authors.forename: Rae S M
authors.initials: RS
authors.lastname: Yeung
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
mesh_terms: D000284:Administration, Oral; D000886:Anthropometry; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects; D000069059:Atorvastatin; D002170:Canada; D002648:Child; D002657:Child Development / Q000187:drug effects*; D002784:Cholesterol / Q000097:blood; D003323:Coronary Aneurysm / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D003331:Coronary Vessels / Q000473:pathology / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006538:Heptanoic Acids / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D007249:Inflammation / Q000188:drug therapy* / Q000503:physiopathology; D008111:Liver Function Tests; D008297:Male; D008501:Medical Records, Problem-Oriented; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D011758:Pyrroles / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies
chemical_list: D000893:Anti-Inflammatory Agents; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D002784:Cholesterol; D000069059:Atorvastatin