The Effect of Statins on Vascular Function in Adolescents with Familial Hypercholesterolemia: A Literature Review

Background: Familial hypercholesterolemia (FH) is characterized by
significantly elevated low-density lipoprotein cholesterol (LDL-C) levels,
increasing the risk of early-onset atherosclerosis. Ultrasound studies
of superficial arteries can non-invasively assess early vascular changes
in children. Flow-mediated dilatation (FMD) and arterial stiffness (AS)
are more sensitive indicators of early atherosclerosis than intima media
thickness (IMT) as they represent the earliest functional alterations in
the arterial wall. However, FMD and AS measurements are technically
challenging and normative values in pediatrics vary substantially. Here,
we review the literature on statin-induced vascular changes in FH.
Results: Two studies investigating the effects on FMD demonstrate
increased FMD levels after treatment initiation with simvastatin. Moreover,
studies evaluating AS show conflicting results, with one study observing an
insignificant increase in AS after fluvastatin treatment and another showing
an insignificant decrease following rosuvastatin therapy. IMT changes
during statin treatment vary across studies, with some showing reductions
after 2 years of pravastatin treatment, while others report improvement
over time with longer statin therapy. Various factors influence vascular
changes during statin treatment, including LDL-C levels, gender, age,
family history of premature cardiovascular disease, and lifestyle factors.
Younger age at statin initiation is associated with better vascular outcomes,
supporting early treatment initiation in FH adolescents.
Conclusions: We highlight the importance of ultrasound studies in
assessing vascular changes in FH adolescents undergoing statin therapy.
Further research should aim to identify the most effective statin type and
treatment targets. Assessing vascular function in the clinical management
of children with FH may improve cardiovascular outcomes.