Pediatric prevention of adult cardiovascular disease: Promoting a healthy lifestyle and identifying at-risk children
- 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 atherosclerotic 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 and Kawasaki disease [KD]) (table 1) [1,2].
Primary prevention measures to minimize the risk of developing atherosclerosis in childhood will be reviewed here. In addition, the primary care assessment to identify the child at risk for premature atherosclerosis, and, by extension, CVD, will also be discussed. Risk factors for early atherosclerosis in childhood and the management of the child at risk for atherosclerosis are reviewed separately. (See "Risk factors and development of atherosclerosis in childhood" and "Overview of the management of the child at risk for atherosclerosis".)
CARDIOVASCULAR HEALTH PROMOTION
The two primary goals of cardiovascular health promotion in children are [1,3]:
●Prevention of the development of risk factors associated with atherosclerosis (primordial prevention) based on general measures that focus on adherence to a healthy lifestyle.
●Identification and management of the child at risk for early atherosclerosis based on the presence of established risk factors including hypertension, obesity, dyslipidemia, insulin resistance, physical inactivity, and smoke exposure. (See "Risk factors and development of atherosclerosis in childhood", section on 'Risk factors'.)
- 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.
- American Academy of Pediatrics. Cardiovascular risk reduction in high-risk pediatric populations. Pediatrics 2007; 119:618.
- Steinberger J, Daniels SR, Hagberg N, et al. Cardiovascular Health Promotion in Children: Challenges and Opportunities for 2020 and Beyond: A Scientific Statement From the American Heart Association. Circulation 2016; 134:e236.
- Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016; 37:2315.
- Laitinen TT, Pahkala K, Magnussen CG, et al. Ideal cardiovascular health in childhood and cardiometabolic outcomes in adulthood: the Cardiovascular Risk in Young Finns Study. Circulation 2012; 125:1971.
- Pahkala K, Hietalampi H, Laitinen TT, et al. Ideal cardiovascular health in adolescence: effect of lifestyle intervention and association with vascular intima-media thickness and elasticity (the Special Turku Coronary Risk Factor Intervention Project for Children [STRIP] study). Circulation 2013; 127:2088.
- Nupponen M, Pahkala K, Juonala M, et al. Metabolic syndrome from adolescence to early adulthood: effect of infancy-onset dietary counseling of low saturated fat: the Special Turku Coronary Risk Factor Intervention Project (STRIP). Circulation 2015; 131:605.
- Liu K, Daviglus ML, Loria CM, et al. Healthy lifestyle through young adulthood and the presence of low cardiovascular disease risk profile in middle age: the Coronary Artery Risk Development in (Young) Adults (CARDIA) study. Circulation 2012; 125:996.
- Gidding SS, Lichtenstein AH, Faith MS, et al. Implementing American Heart Association pediatric and adult nutrition guidelines: a scientific statement from the American Heart Association Nutrition Committee of the Council on Nutrition, Physical Activity and Metabolism, Council on Cardiovascular Disease in the Young, Council on Arteriosclerosis, Thrombosis and Vascular Biology, Council on Cardiovascular Nursing, Council on Epidemiology and Prevention, and Council for High Blood Pressure Research. Circulation 2009; 119:1161.
- Rask-Nissilä L, Jokinen E, Rönnemaa T, et al. Prospective, randomized, infancy-onset trial of the effects of a low-saturated-fat, low-cholesterol diet on serum lipids and lipoproteins before school age: The Special Turku Coronary Risk Factor Intervention Project (STRIP). Circulation 2000; 102:1477.
- Niinikoski H, Viikari J, Rönnemaa T, et al. Prospective randomized trial of low-saturated-fat, low-cholesterol diet during the first 3 years of life. The STRIP baby project. Circulation 1996; 94:1386.
- Kaitosaari T, Rönnemaa T, Raitakari O, et al. Effect of 7-year infancy-onset dietary intervention on serum lipoproteins and lipoprotein subclasses in healthy children in the prospective, randomized Special Turku Coronary Risk Factor Intervention Project for Children (STRIP) study. Circulation 2003; 108:672.
- Niinikoski H, Lagström H, Jokinen E, et al. Impact of repeated dietary counseling between infancy and 14 years of age on dietary intakes and serum lipids and lipoproteins: the STRIP study. Circulation 2007; 116:1032.
- Niinikoski H, Pahkala K, Ala-Korpela M, et al. Effect of repeated dietary counseling on serum lipoproteins from infancy to adulthood. Pediatrics 2012; 129:e704.
- Gidding SS, Dennison BA, Birch LL, et al. Dietary recommendations for children and adolescents: a guide for practitioners. Pediatrics 2006; 117:544.
- Moore LL, Singer MR, Bradlee ML, et al. Intake of fruits, vegetables, and dairy products in early childhood and subsequent blood pressure change. Epidemiology 2005; 16:4.
- Steffen LM, Kroenke CH, Yu X, et al. Associations of plant food, dairy product, and meat intakes with 15-y incidence of elevated blood pressure in young black and white adults: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Clin Nutr 2005; 82:1169.
- Pahkala K, Heinonen OJ, Simell O, et al. Association of physical activity with vascular endothelial function and intima-media thickness. Circulation 2011; 124:1956.
- Pahkala K, Laitinen TT, Heinonen OJ, et al. Association of fitness with vascular intima-media thickness and elasticity in adolescence. Pediatrics 2013; 132:e77.
- Pahkala K, Heinonen OJ, Lagström H, et al. Clustered metabolic risk and leisure-time physical activity in adolescents: effect of dose? Br J Sports Med 2012; 46:131.
- Juonala M, Viikari JS, Kähönen M, et al. Life-time risk factors and progression of carotid atherosclerosis in young adults: the Cardiovascular Risk in Young Finns study. Eur Heart J 2010; 31:1745.
- Ekelund U, Luan J, Sherar LB, et al. Moderate to vigorous physical activity and sedentary time and cardiometabolic risk factors in children and adolescents. JAMA 2012; 307:704.
- Gidding SS, Barton BA, Dorgan JA, et al. Higher self-reported physical activity is associated with lower systolic blood pressure: the Dietary Intervention Study in Childhood (DISC). Pediatrics 2006; 118:2388.
- Farpour-Lambert NJ, Aggoun Y, Marchand LM, et al. Physical activity reduces systemic blood pressure and improves early markers of atherosclerosis in pre-pubertal obese children. J Am Coll Cardiol 2009; 54:2396.
- Tolfrey K, Jones AM, Campbell IG. The effect of aerobic exercise training on the lipid-lipoprotein profile of children and adolescents. Sports Med 2000; 29:99.
- Janz KF, Dawson JD, Mahoney LT. Increases in physical fitness during childhood improve cardiovascular health during adolescence: the Muscatine Study. Int J Sports Med 2002; 23 Suppl 1:S15.
- Gopinath B, Hardy LL, Kifley A, et al. Activity behaviors in schoolchildren and subsequent 5-yr change in blood pressure. Med Sci Sports Exerc 2014; 46:724.
- Lozano P, Henrikson NB, Dunn J, et al. Lipid Screening in Childhood and Adolescence for Detection of Familial Hypercholesterolemia: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2016; 316:645.
- US Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, et al. Screening for Lipid Disorders in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. JAMA 2016; 316:625.
- Lozano P, Henrikson NB, Morrison CC, et al. Lipid Screening in Childhood and Adolescence for Detection of Multifactorial Dyslipidemia: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2016; 316:634.
- Daniels SR. On the US Preventive Services Task Force Statement on Screening for Lipid Disorders in Children and Adolescents: One Step Forward and 2 Steps Sideways. JAMA Pediatr 2016; 170:932.
- Urbina EM, de Ferranti SD. Lipid Screening in Children and Adolescents. JAMA 2016; 316:589.
- 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.
- 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.