Should Children Take Statins?

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Autopsy studies, such as the Pathological Determinants of Atherosclerosis in Youth study and the Bogalusa Heart Study, have demonstrated that the atherosclerotic process begins in childhood. The earliest pathological finding is thought to be a fatty streak which is characterized by an accumulation of lipid filled macrophages within the intima of the artery. The progression ultimately results in a fibrous plaque thought to be responsible for adverse clinical outcomes such as myocardial infarction and ischemic stroke.

Presence of fatty streaks and fibrous plaques was associated with increased traditional risk factors such as elevated cholesterol levels and hypertension. In the Bogalusa study, it was found that the fatty streaks increased with age with about 70% of young adults [who were previously had their risk-factor screened] had fatty streaks. The extent to which the intimal surface was covered with lesions was associated with elevations in total cholesterol, LDL and triglycerides and lower HDL. The increased coverage was positively correlated with risk factors for cardiovascular disease such as dyslipidemia, high blood pressure and obesity. From these and other studies, it is increasingly evident that elevated cholesterol concentrations in childhood are associated with increased risk of atherosclerosis and cardiovascular disease in adulthood.