Top Things to Know: Cardiovascular Risk Reduction in High-Risk Pediatric Patients
- This is an update to the 2006 Scientific Statement on Cardiovascular Risk Reduction in High-Risk Pediatric Patients. Since then, new information has emerged about cardiovascular (CV) risk factors in childhood, and their relationship to premature atherosclerosis and cardiovascular disease (CVD).
- The purpose of this statement is to present considerations for clinical management regarding the assessment and risk reduction of pediatric populations at high risk for premature CVD.
- CVD remains the leading cause of death in the United States. Atherosclerosis and other coronary artery pathology can begin in youth, generally exacerbated by exposure to factors associated with increased cardiovascular risk.
- This statement is directed toward pediatric cardiologists, primary care providers, subspecialists and other clinicians as well as researchers and policy makers concerned with youth at increased risk for premature CVD.
- The statement describes presentations of traditional CVD risk factors during childhood, important high-risk medical conditions, and cardiac and vascular abnormalities that make the young heart more vulnerable to accelerated arteriosclerosis, including coronary artery abnormalities.
- The pathology of adverse CV outcomes in the young is not exact but some themes include familial pathologies, insulin resistance and oxidative stress, dyslipidemia, issues related to chronic kidney disease, hypertension, childhood cancers, congenital heart disease or coronary abnormalities, Kawasaki disease and heart transplant.
- Traditional CV risk factors presenting in childhood are reviewed, including familial hypercholesterolemia, obesity, diabetes and hypertension. In addition, high risk medical conditions are discussed including chronic kidney disease, chronic inflammatory diseases and childhood cancer.
- Individuals with congenital heart disease have structural and functional abnormalities that may make their hearts more vulnerable to both the development of atherosclerosis and the adverse sequelae of a CVD event thus the contribution of premature CVD to long term patient outcomes in this growing population is increasingly important
- Interventions are available to prevent risk factors (primordial prevention), to identify and treat risk factors in childhood (primary prevention), and to address the risk of additional events in those who already have coronary artery pathology (secondary prevention) in childhood.
- Appropriate screening for children and lifestyle modifications, to include a healthy diet and physical activity, are key factors in the prevention, treatment and management of cardiovascular related disease in high-risk pediatric patients.
Citation
de Ferranti SD, Steinberger J, Ameduri R, Baker A, Gooding H, Kelly AS, Mietus-Snyder M, Mitsnefes MM, Peterson AL, St-Pierre J, Urbina EM, Zachariah JP, Zaidi AN, on behalf of the American Heart Association Atherosclerosis, Hypertension and Obesity in the Young Committee of the Council on Lifelong Congenital Heart Disease and Heart Health in the Young, Council on Cardiovascular Radiology and Intervention, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Quality of Care and Outcomes Research.Cardiovascular risk reduction in high-risk pediatric patients: a scientific statement from the American Heart Association [published online ahead of print February 25, 2019]. Circulation. DOI: 10.1161/CIR.0000000000000618.