Diseases associated with atherosclerosis in childhood
- Sarah D de Ferranti, MD, MPH
Sarah D de Ferranti, MD, MPH
- Director, Preventive Cardiology Clinic
- Department of Cardiology
- Boston Children's Hospital
- Jane W Newburger, MD, MPH
Jane W Newburger, MD, MPH
- Commonwealth Professor of Pediatrics
- Harvard Medical School
Although cardiovascular disease (CVD) generally manifests in adulthood, the process of atherosclerosis can begin in early childhood. For most children, atherosclerotic vascular changes are minor and can be minimized or even prevented with adherence to a healthy lifestyle. However, in some children, the process is accelerated because of the presence of identifiable risk factors (table 1) .
Pediatric diseases that are associated with an increased risk of accelerated atherosclerosis and CVD will be discussed here. Identification and management of children at risk for atherosclerosis are discussed separately. (See "Risk factors and development of atherosclerosis in childhood" and "Overview of the management of the child at risk for atherosclerosis".)
RISK STRATIFICATION BASED ON SPECIFIC DISEASES
Specific disease states are associated with early cardiovascular disease (CVD) and accelerated atherosclerosis. In a scientific statement from the American Heart Association (AHA), a panel of experts reviewed the literature on premature cardiovascular disease in children and established a disease risk stratification schema for coronary artery disease (CAD), which was revised into a two-tier schema by the National Heart, Lung, and Blood Institute (NHLBI) panel in 2011 (algorithm 1) [2,3].
This schema separates diseases into high and moderate risk categories for CVD as follows:
●High risk conditions – High risk conditions are associated with pathologic or clinical evidence of CAD before 30 years of age, including the following (see 'High-risk conditions' below):
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- Kavey RE, Allada V, Daniels SR, et al. Cardiovascular risk reduction in high-risk pediatric patients: a scientific statement from the American Heart Association Expert Panel on Population and Prevention Science; the Councils on Cardiovascular Disease in the Young, Epidemiology and Prevention, Nutrition, Physical Activity and Metabolism, High Blood Pressure Research, Cardiovascular Nursing, and the Kidney in Heart Disease; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation 2006; 114:2710.
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- Litwin M, Grenda R, Prokurat S, et al. Patient survival and causes of death on hemodialysis and peritoneal dialysis--single-center study. Pediatr Nephrol 2001; 16:996.
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- Litwin M, Wühl E, Jourdan C, et al. Evolution of large-vessel arteriopathy in paediatric patients with chronic kidney disease. Nephrol Dial Transplant 2008; 23:2552.
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- Mulrooney DA, Yeazel MW, Kawashima T, et al. Cardiac outcomes in a cohort of adult survivors of childhood and adolescent cancer: retrospective analysis of the Childhood Cancer Survivor Study cohort. BMJ 2009; 339:b4606.
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- Neville KA, Cohn RJ, Steinbeck KS, et al. Hyperinsulinemia, impaired glucose tolerance, and diabetes mellitus in survivors of childhood cancer: prevalence and risk factors. J Clin Endocrinol Metab 2006; 91:4401.
- Green DM, Hyland A, Chung CS, et al. Cancer and cardiac mortality among 15-year survivors of cancer diagnosed during childhood or adolescence. J Clin Oncol 1999; 17:3207.
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- Birkebaek NH, Fisker S, Clausen N, et al. Growth and endocrinological disorders up to 21 years after treatment for acute lymphoblastic leukemia in childhood. Med Pediatr Oncol 1998; 30:351.
- Lipshultz SE, Lipsitz SR, Hinkle AS, et al. Cardiovascular status, subsequent risk, and associated factors in long-term survivors of childhood cancer in a population-based study. Circulation 2005; 112 (Suppl 2):476.
- Steinberger J, Sinaiko AR, Kelly AS, et al. Cardiovascular risk and insulin resistance in childhood cancer survivors. J Pediatr 2012; 160:494.
- Pinto NM, Marino BS, Wernovsky G, et al. Obesity is a common comorbidity in children with congenital and acquired heart disease. Pediatrics 2007; 120:e1157.
- Roberts WC. Major anomalies of coronary arterial origin seen in adulthood. Am Heart J 1986; 111:941.
- Click RL, Holmes DR Jr, Vlietstra RE, et al. Anomalous coronary arteries: location, degree of atherosclerosis and effect on survival--a report from the Coronary Artery Surgery Study. J Am Coll Cardiol 1989; 13:531.
- Ou P, Mousseaux E, Azarine A, et al. Detection of coronary complications after the arterial switch operation for transposition of the great arteries: first experience with multislice computed tomography in children. J Thorac Cardiovasc Surg 2006; 131:639.
- Pedra SR, Pedra CA, Abizaid AA, et al. Intracoronary ultrasound assessment late after the arterial switch operation for transposition of the great arteries. J Am Coll Cardiol 2005; 45:2061.
- Gagliardi MG, Adorisio R, Crea F, et al. Abnormal vasomotor function of the epicardial coronary arteries in children five to eight years after arterial switch operation: an angiographic and intracoronary Doppler flow wire study. J Am Coll Cardiol 2005; 46:1565.
- Pasquali SK, Marino BS, Pudusseri A, et al. Risk factors and comorbidities associated with obesity in children and adolescents after the arterial switch operation and Ross procedure. Am Heart J 2009; 158:473.
- Vriend JW, de Groot E, de Waal TT, et al. Increased carotid and femoral intima-media thickness in patients after repair of aortic coarctation: influence of early repair. Am Heart J 2006; 151:242.
- RISK STRATIFICATION BASED ON SPECIFIC DISEASES
- HIGH-RISK CONDITIONS
- Diabetes mellitus
- Chronic kidney disease
- Cardiac transplantation
- Kawasaki disease
- MODERATE-RISK CONDITIONS
- Chronic inflammatory diseases
- HIV infection
- Nephrotic syndrome
- Depressive and bipolar disorders
- OTHER CONDITIONS
- Familial hypercholesterolemia
- Childhood cancer
- Congenital heart disease
- APPROACH TO MANAGEMENT
- INFORMATION FOR PATIENTS