Niacin treatment of hypercholesterolemia in children.

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 +/- SD) was 7.84 +/- 1.14 mmol/L (303 +/- 44 mg/dL), and low-density lipoprotein cholesterol value was 6.28 +/- 1.16 mmol/L (243 +/- 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.