Overview of the management of the child at risk for atherosclerosis
- 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 presents in adulthood, atherosclerosis may begin in childhood. For most children, vascular changes, if present, are mild and can be minimized with adherence to a healthy lifestyle. However, in some children, the atherosclerotic process is accelerated because of the presence of identifiable risk factors (table 1) . Identification of children who are at risk for accelerated atherosclerosis may allow timely intervention to decrease the atherosclerotic process, thereby preventing or delaying CVD [1-3].
An overview of the management of the child identified as being at risk for atherosclerosis will be presented here. Primary prevention of atherosclerosis in children, identifying the child at risk for atherosclerosis, and the risk factors for pediatric atherosclerosis are discussed separately. (See "Pediatric prevention of adult cardiovascular disease: Promoting a healthy lifestyle and identifying at-risk children" and "Risk factors and development of atherosclerosis in childhood".)
RATIONALE FOR INTERVENTION
Large prospective population-based randomized control trial (RCT) studies in adults demonstrate that reducing risk factors associated with cardiovascular disease (CVD) will decrease the risk of CVD. (See "Overview of the risk equivalents and established risk factors for cardiovascular disease", section on 'Established risk factors for atherosclerotic CVD'.)
Although similar long-term outcome data based on randomized clinical trials are not available for the pediatric population, prospective observational studies link risk factors known to be associated with CVD in adults to early atherosclerotic changes in children, and demonstrate tracking of CVD risk factors from childhood to adulthood. Furthermore, short-term RCTs have demonstrated reduction in CVD risk factors in high-risk pediatric populations. (See "Risk factors and development of atherosclerosis in childhood", section on 'Atherosclerotic changes in childhood'.)
As a result, it is reasonable to assume based on the evidence from adult studies and limited pediatric data that timely intervention to decrease and possibly eliminate CVD risk factor(s) in children will decelerate the atherosclerotic process (primordial prevention) and thereby prevent or delay the onset of CVD [2-5].
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- Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents, National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics 2011; 128 Suppl 5:S213.
- AAP statement of endorsement. Expert panel on integrated pediatric guideline for cardiovascular health and risk reduction. http://pediatrics.aappublications.org/content/early/2012/03/21/peds.2012-0210.full.pdf?papetoc=.
- Goldstein BI, Carnethon MR, Matthews KA, et al. Major Depressive Disorder and Bipolar Disorder Predispose Youth to Accelerated Atherosclerosis and Early Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation 2015; 132:965.
- National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114:555.
- Nemet D, Barkan S, Epstein Y, et al. Short- and long-term beneficial effects of a combined dietary-behavioral-physical activity intervention for the treatment of childhood obesity. Pediatrics 2005; 115:e443.