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):To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- 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
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- INFORMATION FOR PATIENTS