Cardiovascular Risk in Pediatric Patients

de Ferranti SD, Steinberger J, Ameduri R, et al.
Cardiovascular Risk Reduction in High-Risk Pediatric Patients: A Scientific Statement From the American Heart Association. Circulation 2019;February 25:[Epub ahead of print].

The following are key points to remember from the American Heart Association (AHA) Scientific Statement on Cardiovascular Risk Reduction in High-Risk Pediatric Patients:

  1. This document is an update of the 2006 AHA Scientific Statement on Cardiovascular Risk Reduction in High-Risk Pediatric Patients.
  2. The document stratifies patients into three tiers of risk for development of cardiovascular disease, including Tier 1: High Risk, Tier II: Moderate Risk, and Tier III: At Risk.
  3. High-risk populations include patients with homozygous familial hyperlipidemia, type 2 diabetes mellitus, chronic kidney disease/end-stage renal disease, post-orthotopic heart transplantation, and Kawasaki disease with current coronary artery aneurysms.
  4. Moderate-risk populations include patients with heterozygous familial hyperlipidemia, chronic inflammatory disease, Kawasaki disease with regressed coronary aneurysms, and type 2 diabetes mellitus.
  5. At-risk (lowest tier or risk) populations include patients with congenital heart disease, Kawasaki disease without detected coronary involvement, and cancer treatment survivors.
  6. For patients of all risk groups, it is recommended that fasting glucose be maintained <100 mg/dl, hemoglobin A1c be maintained <7%, and that blood pressure be maintained ≤90th percentile for age and sex or <120/70 mm Hg.
  7. For high-risk patients, it is recommended that body mass index (BMI) be maintained ≤85th percentile for age and sex, and that low-density lipoprotein (LDL) cholesterol be maintained ≤100 mg/dl.
  8. For moderate-risk patients, it is recommended that BMI be maintained ≤90th percentile for age and sex, and that LDL cholesterol be maintained <130 mg/dl.
  9. For at-risk patients, it is recommended that BMI be maintained ≤95th percentile for age and sex, and that LDL cholesterol be maintained ≤160 mg/dl.
  10. Children with a family history of premature cardiovascular disease or significant hypercholesterolemia should be screened for familial hypercholesterolemia using a fasting lipid profile beginning at 2 years of age and then every 3-5 years through adulthood even if previous profiles are within normal ranges. Treatment for heterozygous familial hyperlipidemia should include statins, low saturated fat diet high in fiber, adequate physical activity, and a smoke-free environment.
  11. Bariatric surgery likely has a role in the management of children with severe obesity and serious comorbidities.
  12. Chronic inflammatory diseases including but not limited to rheumatoid arthritis, psoriasis, inflammatory bowel disease, and systemic lupus erythematosus may impact cardiovascular disease risk in adults. Children with such conditions should be screened on a periodic basis for cardiovascular risk factors.
  13. Childhood cancer survivors are at increased risk of death from cardiovascular disease as compared with age-matched controls. The increased risk is likely multifactorial, with some role of radiation exposure, hematopoietic stem cell transplantation, and increased risk of traditional cardiovascular disease risk factors. All childhood cancer survivors should have a fasting lipid profile and fasting glucose or hemoglobin A1c performed every 2 years.

Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Prevention, Stable Ischemic Heart Disease, Vascular Medicine, Cardiac Surgery and Arrhythmias, Cardiac Surgery and CHD and Pediatrics, Cardiac Surgery and Heart Failure, Cardiac Surgery and SIHD, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Interventions, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Lipid Metabolism, Nonstatins, Heart Transplant, Interventions and Structural Heart Disease, Interventions and Vascular Medicine, Chronic Angina

Keywords: Arthritis, Rheumatoid, Bariatric Surgery, Blood Pressure, Body Mass Index, Cardiovascular Diseases, Cholesterol, LDL, Comorbidity, Coronary Aneurysm, Diabetes Mellitus, Type 2, Glucose, Glycated Hemoglobin A, Heart Defects, Congenital, Heart Transplantation, Hematopoietic Stem Cell Transplantation, Hyperlipidemias, Inflammatory Bowel Diseases, Kidney Failure, Chronic, Lupus Erythematosus, Systemic, Neoplasms, Obesity, Morbid, Pediatrics, Primary Prevention, Psoriasis, Risk Factors, Risk Reduction Behavior

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