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Articles by Brian W. McCrindle
Total Records ( 3 ) for Brian W. McCrindle
  Brian W. McCrindle and Cedric Manlhiot
  Elevated low-density lipoprotein cholesterol (LDL-C) level in childhood is an increasing problem, mainly due to a rising prevalence secondary to the childhood obesity epidemic and better recognition and screening. Vascular changes and impaired endothelial function associated with elevated LDL-C are apparent even in early childhood. Secondary adiposity-related cases are at higher risk due to the clustering of risk factors besides overweight, such as the atherogenic lipid triad, change in the atherogenic properties of the LDL-C particle itself, and the presence of insulin resistance. Prevention should focus on maintaining a healthy lifestyle, including a restricted fat and cholesterol diet, encouraging physical activity, and decreasing sedentary pursuits to maintain an appropriate weight in children. For children and adolescents found to have elevated LDL-C, management should focus on the pursuit of a healthy lifestyle mirroring that for prevention for at least 6 months. Additional dietary therapy, such as plant stanol and sterol esters, have also been shown to modestly reduce LDL-C levels. If the adoption of a healthy lifestyle is not sufficient to reduce LDL-C, lipid-lowering drugs should be considered in selected patients. Current drugs of choice are statins and potentially ezetimibe. Long-term treatment with statins has been shown to markedly reduce carotid intima-media thickness in children and adolescents, particularly when started early. Current evidence supports early and efficient treatment for affected children.
  D. Meeike Kusters , Barbarba A. Hutten , Brian W. McCrindle , David Cassiman , Gordon A. Francis , Claude Gagne , Daniel Gaudet , Katherine M. Morrison , Gisle Langslet , John J. Kastelein and Albert Wiegman
 

Background

Statin therapy is recommended for children with familial hypercholesterolemia (FH), but most children do not reach treatment targets.

Objective

Here we present the design and results at baseline of the ongoing CHARON study, to evaluate the safety and efficacy of rosuvastatin.

Methods

This study comprises an international 2-year open label, titration-to-goal study in 198 children with heterozygous FH aged 6 to 18 years, with rosuvastatin in a maximum dose of 10 mg (<10 years of age) or 20 mg (older children). In addition, 64 unaffected siblings were enrolled as controls. The primary efficacy outcome is the change from baseline in low-density lipoprotein cholesterol, and the secondary outcome is the change in carotid intima-media thickness (c-IMT) in patients with FH compared with their siblings. The primary safety outcomes are growth and sexual maturation; secondary outcomes are the change in other lipoprotein levels and the incidence of adverse events, discontinuation rates, and abnormal laboratory values.

Results

At baseline, mean age of patients with FH was 12.1 ± 3.3 years, 44% were boys, and mean low-density lipoprotein cholesterol levels were 6.1 ± 1.3 mmol/L (235.9 ± 48.7 mg/dL). Mean c-IMT was 0.399 mm (95% CI, 0.392-0.406 mm) in children with FH versus 0.377 (95% CI, 0.366-0.388 mm) in unaffected siblings (P = .001).

Conclusions

At baseline, as expected according to on previous observations, children with FH proved to have a greater c-IMT than their healthy siblings. These differences had already occurred at a very young age, which emphasizes the importance of considering early statin initiation in this high-risk population.

  Nita Chahal , Helen Wong , Cedric Manlhiot and Brian W. McCrindle
 

Background

Although therapeutic lifestyle changes are first-line measures in treating pediatric dyslipidemia, current didactic approaches for healthy lifestyle education are weakened by low adherence and poor sustainability. A collaborative education program including a clinician-led group education class with motivational counseling complemented by the addition of peer role models was implemented.

Objective

We sought to assess the effectiveness of motivational interviewing in collaboration with peers sharing their experience and its impact on serologic and lifestyle measures vs the conventional, didactic group education approach.

Method

Changes in lipid profiles, anthropometric measurements, nutritional scores, physical activity levels, and daily screen time after 6 months were compared both within groups and between the collaborative and the didactic approach.

Results

We reviewed 75 children ages 11.1 ± 3.5 years (n = 38 didactic/n = 37 collaborative). There were no group differences at baseline. Total cholesterol (5.79 ± 1.65 mmol/L vs 5.52 ± 1.39 mmol/L, P = .02) significantly decreased between the initial visit and the 6-month follow-up assessment with both approaches. Nutrition compliance scores significantly improved with both approaches (median: 5.3/10 vs 6.6/10, P = .004), with a marginally greater improvement for the collaborative (+1.7/10) vs the didactic approach (+1.0/10, P = .12). The collaborative approach was associated with greater reductions in weight percentile (−8.9% vs +1.8%, P = .03) and screen time (−7.0 h/wk vs +1.3 h/wk, P = .05) and a greater increase in physical activity (+4.0 h/wk vs +2.0 h/wk, P = .05).

Conclusion

Although not associated with differences in lipid profiles, the collaborative educational approach was associated with a greater lifestyle improvement than was the didactic approach over a 6-month period.

 
 
 
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