Response by Kusters et al to Letter Regarding Article, “Effect of Rosuvastatin on Carotid Intima-Media Thickness in Children With Heterozygous Familial Hypercholesterolemia: The CHARON Study (Hypercholesterolemia in Children and Adolescents Taking Rosuvastatin Open Label)”

We appreciate the comments of Dr Koh regarding our recent publication in Circulation .1 We comment here on the issues raised. Undoubtedly, patients with heterozygous familial hypercholesterolemia (HeFH) should be treated with lipid-lowering medication from a young age to prevent premature cardiovascular disease. However, from what age exactly and to what extent low-density lipoprotein (LDL) cholesterol (LDL-C) should be lowered remain difficult questions, and the answers are probably different for each individual because many factors contribute to cardiovascular risk. From the baseline data of the CHARON trial (Hypercholesterolemia in Children and Adolescents Taking Rosuvastatin Open Label), the difference in carotid intima-media thickness (c-IMT) between subjects with HeFH and unaffected siblings was shown to be significant before the age of 8 years.2 This finding may suggest that statins should be started possibly from a younger age than is currently recommended because treatment should preferably be started before the process of atherosclerosis is detectable. Another study …