A randomized, double blind, placebo-controlled pilot trial of the safety and efficacy of atorvastatin in children with elevated low-density lipoprotein cholesterol (LDL-C) and type 1 diabetes

TitleA randomized, double blind, placebo-controlled pilot trial of the safety and efficacy of atorvastatin in children with elevated low-density lipoprotein cholesterol (LDL-C) and type 1 diabetes
Publication TypeJournal Article
Year of Publication2015
AuthorsCanas, J. A., Ross J. L., Taboada M. V., Sikes K. M., Damaso L. C., Hossain J., Caulfield M. P., Gidding S. S., & Mauras N.
JournalPediatric diabetes
Volume16
Issue2
Pagination79-89
Date Published2015 Mar
ISSN1399-5448
KeywordsAdolescent; Adolescents; Atorvastatin Calcium; cardiovascular disease; Child; Cholesterol, LDL; Combined Modality Therapy; Diabetes Mellitus, Type 1; Diet, Diabetic; Diet, Fat-Restricted; Double-Blind Method; Drug Monitoring; Exercise; Female; Hemoglobin A, Glycosylated; Heptanoic Acids; HMG-CoA; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypercholesterolemia; Hyperglycemia; Hypoglycemic Agents; Insulin; Insulin Resistance; Male; Pilot Projects; Pyrroles; Statins
Abstract

BACKGROUND: Children with type 1 diabetes (T1D) and elevated LDL-C have an increased risk for cardiovascular disease, a process that can begin in childhood.
OBJECTIVE: To assess the safety and efficacy of atorvastatin improving lipid profiles in children with T1D and elevated LDL-C.
SUBJECTS: Sixty children (31M/29F) with T1D, mean age: 15 ± 0.3 yr, mean diabetes duration: 6.8 ± 0.5 yr, HbA(1c) : 8.8 ± 0.2%, with mean LDL-C 124 ± 4.0mg/dl were recruited.
METHODS: After a 3-month run-in period, subjects were randomized double-blindly to atorvastatin or placebo for 6 months. Lipoprotein subfractions were measured by ion mobility and glucose control by HbA1C; continuous glucose monitors were worn quarterly.
RESULTS: After a run-in period, 42 subjects were randomized. There were decreases in total cholesterol (-21%), LDL-C (-32%), non-HDL-C (-31%) and apoB (-26%) in the atorvastatin group versus placebo (p < 0.001). Lipoprotein subparticles (LDL-large 1 and 2A, IDL-large and small, VLDL- medium and small) decreased with statins (p < 0.03 all). Insulin sensitivity scores remained constant in both groups and correlated inversely with apoB (r = -0.312 p = 0.039) and small LDL 3A (r = -0.404 p = 0.007). One subject had asymptomatic elevation of creatinine kinase which normalized after atorvastatin discontinuation.
CONCLUSIONS: Atorvastatin lowered LDL-C, apoB, and atherogenic lipoprotein subparticles in children with T1D and elevated LDL-C without worsening insulin resistance. The drug was well tolerated and safe. Long-term studies would provide better insight on the impact of these interventions in the development of cardiovascular disease in children with diabetes.






DOI10.1111/pedi.12245
Alternate JournalPediatr Diabetes
Refereed DesignationRefereed