Risk factors and development of 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) is generally manifest in adulthood, the process of atherosclerosis can begin early in 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 (eg, obesity and hypertension) and/or specific diseases that are associated with premature CVD (eg, diabetes mellitus) [1,2].
The evidence linking atherosclerotic changes in childhood to CVD will be reviewed here. In addition, risk factors in childhood that are associated with early atherosclerosis and CVD will also be discussed (table 1).
Primary pediatric intervention to reduce or minimize atherosclerosis, and identifying and managing the child at risk for atherosclerosis, are discussed separately. (See "Pediatric prevention of adult cardiovascular disease: Promoting a healthy lifestyle and identifying at-risk children" and "Overview of the management of the child at risk for atherosclerosis".)
ATHEROSCLEROTIC CHANGES IN CHILDHOOD
Overview — Evidence for the development of atherosclerosis in childhood includes autopsy studies showing atherosclerotic changes in the young, and noninvasive, indirect data showing vascular changes associated with adult cardiovascular disease (CVD).
In addition, these studies demonstrate an association between premature atherosclerosis and well-established adult CVD risk factors (eg, overweight/obesity, hypertension, dyslipidemia, and smoke exposure).
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- ATHEROSCLEROTIC CHANGES IN CHILDHOOD
- Direct evidence from autopsy studies
- Indirect evidence
- - Longitudinal prospective studies
- RISK FACTORS
- Overweight and obesity
- Metabolic syndrome
- Family history
- Smoke exposure
- Special risk conditions
- Prenatal factors
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS