Opinion statement
Most children who are normal weight for height and otherwise healthy have risk factor levels associated with the absence of heart disease (ie, they do not smoke, do not have diabetes, are physically active, have low-density lipoprotein levels < 110 mg/dL, and have blood pressure < 120/80 mm Hg). However, by adolescence, the earliest lesions in the atherosclerotic process, fatty streaks and raised lesions, are present in the coronary arteries and the abdominal aorta. The severity of early atherogenesis is related to the coexistence of the major cardiovascular risk factors. Most commonly, the associated risk disturbances are mild: borderline hypertension, mild dyslipidemia, insulin resistance, overweight, physical inactivity, and initiation of tobacco use. Rarely, more severe risk factors are present: familial hypercholesterolemia (a genetic disorder of lipid metabolism), diabetes mellitus, secondary hypertension of long standing, or risk factors associated with chronic conditions such as end-stage renal disease. Thus, cardiovascular risk management in this age group has two components: primordial prevention (the prevention of the development of cardiovascular risk in the first place) and primary prevention (more aggressive treatment of identified risk factors in high-risk individuals either through behavioral or pharmacologic means). Trials beginning in adolescence of the primary prevention of atherosclerosis-related diseases have not been undertaken; thus, the decision to initiate pharmacologic management in high-risk adolescents requires careful thought.
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References and Recommended Reading
McMahan CA, Gidding SS, Fayad ZA, et al: Risk scores predict atherosclerotic lesions in young people. Arch Intern Med 2005, 165:883–890. Discusses the relationship of cardiovascular risk factors measured postmortem to early atherogenesis.
Wiegman A, Hutten BA, de Groot E, et al: Efficacy and safety of statin therapy in children with familial hypercholesterolemia: a randomized controlled trial. JAMA 2004, 292:331–337.
Parekh R, Gidding SS: Cardiovascular complications in pediatric end-stage renal disease. Pediatr Nephrol 2005, 20:125–131.
American Diabetes Association: Management of dyslipidemia in children and adolescents with diabetes. Diabetes Care 2003, 26:2194–2197.
Newburger JW, Takahashi M, Gerber MA, et al: Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 2004, 110:2747–2771.
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 [no authors listed]. Pediatrics 2004, 114:555–576. Highly detailed recommendations for management of hypertension in youth.
National Cholesterol Education Program (NCEP): highlights of the report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents [no authors listed]. Pediatrics 1992, 89:495–501.
Daniels SR, Arnett DK, Eckel RH, et al: Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment. Circulation 2005, 111:1999–2012.
Active and passive tobacco exposure: a serious pediatric health problem. A statement from the Committee on Atherosclerosis and Hypertension in Children, Council on Cardiovascular Disease in the Young, American Heart Association [no authors listed]. Circulation 1994, 90:2581–2590.
Williams CL, Hayman LL, Daniels SR, et al.: Cardiovascular health in childhood: a statement for health professionals from the Committee on Atherosclerosis, Hypertension, and Obesity in the Young (AHOY) of the Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 2002, 106:143–160. Comprehensive risk factor reduction guidelines for children and adolescents.
National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002, 106:3143–3421.
Gidding SS, Dennison BA, Birch LL, et al: Dietary recommendations for children and adolescents: a guide for practitioners: consensus statement from the American Heart Association. Circulation 2005, 112:2061–2075.
Strong WB, Malina RM, Blimkie CJ, et al: Evidencebased physical activity for school-age youth. J Pediatr 2005, 146:732–737.
McGill HC Jr, McMahan CA, Malcom GT, et al.: Relation of glycohemoglobin and adiposity to atherosclerosis in youth. Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. Arterioscler Thromb Vasc Biol 1995, 15:431–440.
Carnethon MR, Gidding SS, Nehgme R, et al: Cardiorespiratory fitness in young adulthood and the development of cardiovascular disease risk factors. JAMA 2003, 290:3092–3100.
Appel LJ, Moore TJ, Obarzanek E, et al: A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med 1997, 336:1117–1124.
Newman TB, Browner WS, Hulley SB: The case against childhood cholesterol screening. JAMA 1990, 264:3039–3043.
Gidding SS: The rationale for lowering serum cholesterol levels in American children. Am J Dis Child 1993, 147:386–392.
Stein EA, Illingworth DR, Kwiterovich PO Jr, et al: Efficacy and safety of lovastatin in adolescent males with heterozygous familial hypercholesterolemia: a randomized controlled trial. JAMA 1999, 281:137–144.
de Jongh S, Lilien MR, Op’t Roodt J, et al: Early statin therapy restores endothelial function in children with familial hypercholesterolemia. J Am Coll Cardiol 2002, 40:2117–2121.
McCrindle BW, Ose L, Marais AD: Efficacy and safety of atorvastatin in children and adolescents with familial hypercholesterolemia or severe hyperlipidemia: a multicenter, randomized, placebo-controlled trial. J Pediatr 2003, 143:74–80.
Thompson GR: LDL apheresis. Atherosclerosis 2003, 167:1–13.
Harris WS: Nonpharmacologic treatment of hypertriglyceridemia: focus on fish oils. Clin Cardiol 1999, 22:II40-II43.
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Gidding, S.S. Cardiovascular risk factors in adolescents. Curr Treat Options Cardio Med 8, 269–275 (2006). https://doi.org/10.1007/s11936-006-0047-1
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DOI: https://doi.org/10.1007/s11936-006-0047-1