title: Long-term pharmacotherapy for elevated low density lipoprotein levels in children: A retrospective analysis.
abstract: BACKGROUND
  There is limited research detailing low-density lipoprotein cholesterol (LDL-C) trends over the long term in children on various lipid-lowering medications.
  
  
  OBJECTIVE
  This study sought to assess factors associated with stability of LDL-C levels in children on long-term pharmacotherapy and their ability to reach the LDL-C goal of ≤130 mg/dL while on pharmacotherapy.
  
  
  METHODS
  Medical records of children seen in a university pediatric cholesterol clinic between 1998 and 2012 treated with a statin, ezetimibe, or both were reviewed. Aggregate data were obtained to determine the number of children able to reach an LDL-C level of ≤130 mg/dL while on pharmacotherapy. Kaplan-Meier curve and proportional hazard regression analysis were used to examine the propensity for LDL-C levels to stabilize over time while on pharmacotherapy as well as factors affecting this propensity.
  
  
  RESULTS
  Overall, 76 patients who contributed 864 total visits were included. Of the 76 patients, 56 developed a stable LDL-C with median time to stability of 28 months on pharmacotherapy. Younger age at first visit and higher medication potencies/doses were associated with an increased propensity to stabilize. Only 36 patients were able to reach an LDL-C of ≤130 mg/dL, with only 11 of 38 patients with probable familial hypercholesterolemia reaching this goal.
  
  
  CONCLUSIONS
  Most children reached LDL-C stability on pharmacotherapy after a median 28-month interval. However, most children had difficulty in reaching the LDL-C goal of ≤130 mg/dL even with aggressive medication titration. This was specifically true for those with probable familial hypercholesterolemia.
authors.affiliation: Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV, USA. Electronic address: cjohn@hsc.wvu.edu.
authors.forename: Collin C
authors.initials: CC
authors.lastname: John
authors.affiliation: Department of Biostatistics, West Virginia University School of Public Health, Morgantown, WV, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Regier
authors.affiliation: Department of Biostatistics, West Virginia University School of Public Health, Morgantown, WV, USA.
authors.forename: Christa L
authors.initials: CL
authors.lastname: Lilly
authors.affiliation: Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV, USA.
authors.forename: Shahenda
authors.initials: S
authors.lastname: Aly
mesh_terms: D000924:Anticholesteremic Agents / Q000494:pharmacology*; D002648:Child; D008078:Cholesterol, LDL / Q000378:metabolism*; D000069438:Ezetimibe / Q000494:pharmacology; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology; D053208:Kaplan-Meier Estimate; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000069438:Ezetimibe
keywords: Ezetimibe; Lipid; Low-density lipoprotein; Pediatric; Statin