Niacin treatment of hypercholesterolemia in children

Controversy surrounds the treatment of hypercholesterolemia in children. The National Cholesterol Education Program has recommended the possibility of drug treatment only after diet treatment for high cholesterol levels has been tried and proven ineffective. The efficacy and adverse effects of niacin treatment of hypercholesterolemia were investigated in a retrospective review of 21 children, ages 4 to 14 years, who received 550 to 2250 mg/day of niacin for severe hypercholesterolemia. Daily doses of more than 1000 mg reduced total cholesterol by 23% and low-density lipoprotein cholesterol by 30%, but it produced no measurable reduction of high-density lipoprotein cholesterol or triglycerides. Although the treatment was helpful, adverse, reversible side effects occurred, prompting researchers to conclude that niacin should be reserved for use in carefully supervised treatment of severe hypercholesterolemia by a lipid specialist.
Objective. To determine the efficacy and adverse effects of niacin treatment of hypercholesterolemia in children. Design. Retrospective review. Setting. Two university hospital referral clinics. Patients. All children who received single-drug niacin treatment for severe hypercholesterolemia between 1980 and 1991. Results. Twenty-one children, aged 4 to 14 years, were treated with niacin, 500 to 2250 mg daily. Pretreatment total serum cholesterol value (mean [+ or -] SD) was 7.84 [+ or -] 1.14 mmol/L (303 [+ or -] 44 mg/dL), and low-density lipoprotein cholesterol value was 6.28 [+ or -] 1.16 mmol/L (243 [+ or -] 45 mg/dL). Niacin treatment in daily doses >1000 mg reduced total cholesterol by 23% and low-density lipoprotein cholesterol by 30% (P < .001) but had no effect on high-density lipoprotein cholesterol and triglycerides. As in adults, reversible adverse effects were common, occurring in 16 (76%) of the 21 children. Six children (29%) had reversible dose-related elevations of serum aminotransferase levels. Niacin therapy was discontinued in 8 children (38%) because of flushing, abdominal pain, vomiting, headache, or elevated serum aminotransferase levels. Conclusions. This study suggests that although niacin treatment in children is efficacious, adverse effects are common. Until further study demonstrates long-term safety, niacin treatment should be reserved for the closely-supervised treatment of severe hypercholesterolemia by a lipid specialist. Pediatrics 1993;92:78-82; cholesterol, hypercholesterolemia, niacin.