Statin Use Not Linked to Insulin Resistance Changes in Children with Hypercholesterolemia

Urh Groselj, MD, PhD

Short-term treatment with rosuvastatin was not associated with changes in insulin resistance markers in a cohort of children with familial hypercholesterolemia, according to new findings.

The substantial reductions in low-density lipoprotein cholesterol (LDL-C) among children and adolescents taking rosuvastatin were not followed by increased fasting glucose, fasting insulin, HOMA-IR, and HbA1c levels after 7 months.

“In contrast, studies of adults suggest that changes can be observed 10 weeks after statin initiation,” wrote study author Urh Groselj, MD, PhD, Department of Endocrinology, Diabetes, and Metabolism, University Children’s Hospital Ljubljana, Faculty of Medicine, University of Ljubljana.

As the first-line treatment for lowering LDL-C in this pediatric population, clinical trials have proven the efficacy, safety, and impressive tolerability of statins. In adults, statins are associated with increased insulin resistance, insulin secretion, and type 2 diabetes (T2D) risk.

The available data on the effects of statins on glucose homeostasis are lacking for children, who require lifelong lipid-lowering treatment (LLT). Groselj and colleagues assessed the association between treatment with statins and changes in insulin resistance markers in children and adolescents in Slovenia.

Children and adolescents diagnosed with familial hypercholesterolemia were included if they had fasting insulin and glucose measurements for 2 consecutive visits between 2016 and 2021.

Individuals who were prescribed 5 mg of rosuvastatin at baseline, had unmodified therapy between consecutive visits, and had a ≥20% reduction in LDL-C from baseline made up the treatment group. Those considered the control group were individuals receiving no therapy despite the intention to treat. Data on race and ethnicity were self-reported by participants or the parent or caregiver.

The study population included 35 participants, consisting of 20 in the treatment group (8 girls [40.0%], 12 boys [60.0%]; median age, 10.0 years) and 15 in the control group (7 girls [46.7%], 8 boys [53.3%]; median age, 10.2 years).

The investigators noted 18 patients in the treatment group (90.0%) and 9 participants in the control group (60.0%) had a positive genetic test result for familial hypercholesterolemia. All patients self-reported race and ethnicity as White.

The team performed treatment and control group follow-up visits were performed at a median of 7.4 and 13.4 months (P = .03) from baseline, respectively.

Median baseline LDL-C was found higher among the treatment group than the control group participants (209 versus 174 mg/dL; P = .01), while glucose homeostasis parameters at baseline were comparable. Data show individuals taking rosuvastatin had median reductions of 40.2% in LDL-C and 32.6% in total cholesterol (P <.001).

Investigators added that no changes in LDL-C and total cholesterol were observed among those in the control group and end-of-study LDL-C levels were lower in the treatment group. There was no change in median body mass index (BMI) index z scores among treatment or control participants.

The study, “Analysis of Insulin Resistance Among Children and Adolescents in Slovenia with Hypercholesterolemia After Treatment with Statins,” was published in JAMA Network Open.