Statin adherence and LDL-C reduction in a pediatric population

Statins have demonstrated efficacy and safety in children with primary dyslipidemias such as familial hypercholesterolemia; however, adherence plays a key role in the ability of a statin to lower low-density lipoprotein cholesterol (LDL-C) levels. The objective of this study was to examine the role medication adherence plays in statin efficacy for the treatment of primary and secondary pediatric dyslipidemias. Retrospective review of a pediatric preventive cardiology database identified all subjects < 22 years old who were prescribed a statin. Dosing, adverse effects, pre- and on-treatment LDL-C levels, medication adherence, and family history of atherosclerotic cardiovascular disease (ASCVD) were recorded. Adherence to medication was considered adequate if subject self-reported taking >= 80% of prescribed doses in the 14 days prior to lowest treatment LDL-C value. Chart review identified 131 subjects aged 6-21 years prescribed a statin with pre- and on-treatment data available. Of these 131 subjects, 123 (94%) had LDL-C > 130 mg/dL before beginning a statin. On treatment, 100/131 subjects (76%) met the LDL-C target of <= 130 mg/dL. Of 83 subjects with adherence data available, 61 (73%) met the adherence threshold and the adherent group had significantly greater mean reduction in LDL-C compared to the non-adherent group (-91 mg/dL versus -20 mg/dL, p = .0001). There were no reported adverse effects. These findings indicate that reductions in LDL-C were dependent on medication adherence. Utilizing a model of early intervention, family education, and intensive follow-up to improve adherence may improve clinical outcomes and reduce future ASCVD events in children with primary and secondary dyslipidemias that require lipid-lowering therapy.