Abstract Body (Do not enter title and authors here): Background: Combined dyslipidemia of obesity (CDO) is prevalent in ~20% of youth and characterized by high numbers of atherogenic small LDL (sLDL) particles associated with stiffer arteries. The safety and impact of statin therapy is not known.
Methods: A 2-year randomized trial of pitavastatin calcium 4 mg/day versus placebo for participants ages 10-19 years with body mass index (BMI) >85^th %ile and CDO defined as non-HDL-C >120 mg/dL and either low HDL-C or high triglyceride (TG):HDL-C ratio was performed. The primary outcome was change in carotid-femoral pulse wave velocity (PWV) assessed at baseline, 6, 12, 18, and 24 months. Secondary outcomes included safety and lipid measures.
Results: Across 18 sites, 59 participants were randomized to pitavastatin and 60 to placebo. Demographic (mean age 13.5+1.2 yrs; 55% males), anthropomorphic (BMI %ile 98+3; waist/height ratio 0.66+0.08), lipid (non-HDL-C 167+29 mg/dL, LDL-C 127+25 mg/dL, HDL-C 37+7 mg/dL, TG/HDL ratio 6.4+4.7, sLDL number 866+419 nmol/L), vascular (PWV 5.0+0.7 m/sec) and safety measures were similar at baseline between groups. There were 28 early terminations (11 pitavastatin, 17 placebo). Significant reductions with pitavastatin versus placebo were noted in non-HDL-C (median -25% vs +3% at 6 months, p<0.001), LDL-C (-29% vs +7%, p<0.001), and apolipoprotein B (-26% vs 0%, p<0.001). An early reduction relative to placebo in sLDL particle number was not sustained (FIGURE A), and there were no significant changes or trends for PWV (FIGURE B) in either group. There was one serious adverse event (placebo), and no significant differences in liver enzymes, muscle toxicity, glucose homeostasis, or linear growth, including adiposity which did not change over the course of the study.
Conclusions: Over 2 years, treatment of CDO in adolescents with pitavastatin calcium resulted in significant improvement in dyslipidemia with no safety concerns. No change in PWV in either group may be due to lower-than-expected baseline PWV, insufficient magnitude of impact on CDO, or lack of change in adiposity.