title: Correlates of Achieving Statin Therapy Goals in Children and Adolescents with Dyslipidemia.
abstract: OBJECTIVE
  To determine the real-world effectiveness of statins and impact of baseline factors on low-density lipoprotein cholesterol (LDL-C) reduction among children and adolescents.
  
  
  METHODS
  We analyzed data prospectively collected from a quality improvement initiative in the Boston Children's Hospital Preventive Cardiology Program. We included patients ≤21 years of age initiated on statins between September 2010 and March 2014. The primary outcome was first achieving goal LDL-C, defined as <130 mg/dL, or <100 mg/dL with high-level risk factors (eg, diabetes, etc). Cox proportional hazards models were used to assess the impact of baseline clinical and lifestyle factors.
  
  
  RESULTS
  Among the 1521 pediatric patients evaluated in 3813 clinical encounters over 3.5 years, 97 patients (6.3%) were started on statin therapy and had follow-up data (median age 14 [IQR 7] years, 54% were female, and 24% obese, 62% with at least one lifestyle risk factor). The median baseline LDL-C was 215 (IQR 78) mg/dL, and median follow-up after starting statin was 1 (IQR 1.3) year. The cumulative probability of achieving LDL-C goal within 1 year was 60% (95% CI 47-69). A lower probability of achieving LDL-C goals was associated with male sex (HR 0.5 [95% CI 0.3-0.8]) and higher baseline LDL-C (HR 0.92 [95% CI 0.87-0.98] per 10 mg/dL), but not age, body mass index percentile, lifestyle factors, or family history.
  
  
  CONCLUSIONS
  The majority of pediatric patients started on statins reached LDL-C treatment goals within 1 year. Male patients and those with greater baseline LDL-C were less likely to be successful and may require increased support.
authors: Department of Cardiology, Boston Children's Hospital, Boston, MA; Boston University School of Medicine, Boston University, Boston, MA. Electronic address: Michael.Mendelson@cardio.chboston.org.
authors: Michael M
authors: MM
authors: Mendelson
authors: Institute for Relevant Clinical Data Analytics (IRCDA), Boston Children's Hospital, Boston, MA.
authors: Todd
authors: T
authors: Regh
authors: Institute for Relevant Clinical Data Analytics (IRCDA), Boston Children's Hospital, Boston, MA.
authors: James
authors: J
authors: Chan
authors: Department of Cardiology, Boston Children's Hospital, Boston, MA.
authors: Annette
authors: A
authors: Baker
authors: Department of Cardiology, Boston Children's Hospital, Boston, MA.
authors: Heather Harker
authors: HH
authors: Ryan
authors: Department of Cardiology, Boston Children's Hospital, Boston, MA.
authors: Nicole
authors: N
authors: Palumbo
authors: Department of Cardiology, Boston Children's Hospital, Boston, MA.
authors: Philip K
authors: PK
authors: Johnson
authors: Department of Cardiology, Boston Children's Hospital, Boston, MA.
authors: Suzanne
authors: S
authors: Griggs
authors: Department of Cardiology, Boston Children's Hospital, Boston, MA; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA.
authors: Meera
authors: M
authors: Boghani
authors: Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA.
authors: Nirav K
authors: NK
authors: Desai
authors: Department of Cardiology, Boston Children's Hospital, Boston, MA; Boston University School of Medicine, Boston University, Boston, MA.
authors: Elizabeth
authors: E
authors: Yellen
authors: Department of Cardiology, Boston Children's Hospital, Boston, MA.
authors: Lucy
authors: L
authors: Buckley
authors: Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA.
authors: Matthew W
authors: MW
authors: Gillman
authors: Department of Cardiology, Boston Children's Hospital, Boston, MA.
authors: Justin P
authors: JP
authors: Zachariah
authors: Institute for Relevant Clinical Data Analytics (IRCDA), Boston Children's Hospital, Boston, MA.
authors: Dionne
authors: D
authors: Graham
authors: Department of Cardiology, Boston Children's Hospital, Boston, MA.
authors: Sarah D
authors: SD
authors: de Ferranti
mesh_terms: D000293:Adolescent; D001900:Boston; D002648:Child; D008078:Cholesterol, LDL / Q000097:blood*; D050171:Dyslipidemias / Q000188:drug therapy*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: dyslipidemia; low-density lipoprotein cholesterol; pediatrics; statins