Primary Prevention of Cardiovascular Disease in Childhood: Recent Knowledge and Unanswered Questions

Efforts at prevention of chronic disease in adult life must include investigation of causal pathogenetic clues in early life. There is adequate rationale for identification of children who are at risk of developing cardiovascular disease (CVD) in later years. At the present time, practical considerations would favor a selective rather than universal screening of children. If the latter is instituted, then it is ideal to test children 4-7 years of age. In either case, total cholesterol greater than 200 mg/dl warrants a complete lipid-lipoprotein profile. Those with confirmed abnormal values of total cholesterol, low-density lipoprotein cholesterol, and apolipoproteins A1 and B should be offered dietary advice and encouraged to participate in regular exercise. In a few cases, drug therapy would be required. Limited data suggest that an integrated approach will result in a reduction of cardiovascular risk factors. Perinatal nutrition also may influence the risk of CVD among adults; a reduction in the prevalence of low birth weight and prevention of failure to thrive in early infancy may be additional useful strategies for prevention of CVD.