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].
Subscribers log in hereLiterature review current through: Jul 2017. | This topic last updated: Sep 07, 2016.References
- Berenson GS, Srinivasan SR, Bao W, et al. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med 1998; 338:1650.
- American Academy of Pediatrics. Cardiovascular risk reduction in high-risk pediatric populations. Pediatrics 2007; 119:618.
- McCrindle BW, Urbina EM, Dennison BA, et al. Drug therapy of high-risk lipid abnormalities in children and adolescents: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee, Council of Cardiovascular Disease in the Young, with the Council on Cardiovascular Nursing. Circulation 2007; 115:1948.
- 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.
- 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.