While
cardiovascular disease is rare in children, risk factors present in
childhood can greatly increase the likelihood a child will develop
heart disease as an adult. In response, new guidelines sponsored by the
National Heart, Lung and Blood Institute (NHLBI), part of the National
Institutes of Health, and endorsed by the American Academy of
Pediatrics (AAP) will give health care providers an integrated road map
to address all the major cardiovascular risk factors as part of
regular well-child visits.
“The Expert Panel
Report on Integrated Guidelines for Cardiovascular Health and Risk
Reduction in Children and Adolescents,” will be published online Nov.
14, 2011 in the journal Pediatrics and will be a supplement to
the December 2011 print issue. The article will also be posted online
as a preprint Sunday, Nov. 13, on the NHLBI website at: http://www.nhlbi.nih.gov/guidelines/cvd_ped/. The guidelines were written by an expert panel that reviewed and graded the available evidence.
The new
guidelines recommend ways to prevent the development of cardiovascular
risk factors and optimize cardiovascular health starting with breast
feeding and emphasizing a diet low in saturated fat starting at age 1
year. The guidelines also encourage protection from tobacco smoke as
well as regular physical activity.
“The more we
learn about heart disease and stroke in adults, the more we know that
the process begins in childhood and progresses over time,” said Stephen
R. Daniels, MD, PhD, FAAP, chair of the expert panel that reviewed the
guidelines. “By working with families, we can keep kids at a lower
lifetime risk and prevent more serious problems in adulthood.”
A significant
change from previous guidelines is the new recommendation that all
children be screened for high cholesterol at least once between the ages
of 9 and 11 years, and again between ages 17 and 21 years. The NCEP
Expert Panel on Blood Cholesterol Levels in Children and Adolescents,
issued in 1992, instead called for screening only children with a
family history of heart disease or high cholesterol. Physicians now
will be able to use a non-HDL cholesterol test that does not require
children to fast; children with abnormal results should be followed up
with a fasting lipid profile.
It is anticipated
that a universal screening will more accurately identify children who
are at high risk of cardiovascular disease and allow pediatricians to
follow up, Dr. Daniels said.
Less than 1
percent of children – primarily those with genetic dyslipidemias – would
qualify for cholesterol-lowering medications. Most children with high
cholesterol would be referred to lifestyle modifications including diet
and physical activity; for children with high blood pressure, the DASH
diet is recommended.
The guideline
also identifies age-specific strategies to reduce risk factors and
manage cardiovascular disease in children and adolescents.
“We’re aware that
pediatricians have a long list of things they have to address as part
of health promotion and disease prevention. This is really an important
part of what should be on that list,” Dr. Daniels said. “We as
pediatricians really need to get kids started on the right track and
keep them in as low a risk category as possible.”
For a copy of the summary report, or for an interview with the authors, contact the AAP Department of Communications.
###
The American Academy of
Pediatrics is an organization of 60,000 primary care pediatricians,
pediatric medical subspecialists and pediatric surgical specialists
dedicated to the health, safety and well-being of infants, children,
adolescents and young adults. For more information, visit www.aap.org.
