Reduction of Risk for Cardiovascular Disease in Children and Adolescents

Q: What are the key findings of this study?

Integrated family-based lifestyle and clinical interventions in childhood and adolescence can prevent and ameliorate cardiovascular risk factors that track into adulthood.

Q: What is the clinical evidence from this study?

Study design: Review. Population: Cardiovascular disease risk factors in children and adolescents (obesity, hypertension, dyslipidemia, physical inactivity, tobacco use). Intervention: Primordial and primary prevention strategies (dietary modification, physical activity, weight management, blood pressure control, lipid management, and smoking prevention/cessation). Primary outcome: Reduction and prevention of cardiovascular disease risk factors and subclinical atherosclerosis in youth.

Stephen R. Daniels; CHARLOTTE A. PRATT; Laura Lucia Hayman

doi:10.1161/circulationaha.110.016170

October 10, 2011CirculationOpen Access

Reduction of Risk for Cardiovascular Disease in Children and Adolescents

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Key result

Family-based lifestyle and clinical interventions in youth reduce cardiovascular risk factors that track into adulthood.

Key Points

To synthesize published evidence and recommendations on the epidemiology of cardiovascular disease risk factors in youth and outline clinical approaches for primordial and primary prevention.
Narrative synthesis and review of published clinical trials, observational cohorts, and autopsy studies examining the origins and progression of atherosclerosis in youth.
Evaluation of pediatric lifestyle factors, dietary recommendations, and physical activity guidelines for primary care practice.
Autopsy and vascular imaging studies demonstrate that advanced atherosclerotic lesions, including fibrous plaques and increased carotid intima-medial thickness, develop during childhood in association with elevated body mass index, blood pressure, LDL cholesterol, and smoking.
Diets restricting total fat to less than 30% of energy, saturated fat to 8–10% of energy, and dietary cholesterol to 200–300 mg/d significantly reduced total cholesterol, LDL cholesterol, and C-reactive protein in clinical trials.
Longitudinal data with up to 21 years of follow-up indicate that physical activity levels and healthful dietary behaviors established in childhood track into adulthood, and maintaining low cardiovascular risk status to age 50 substantially reduces lifetime disease incidence.

Structured PICO

P

Population

Children, adolescents, and young adults in the United States evaluated for cardiovascular disease risk factors and primordial/primary prevention strategies.

I

Intervention

Primordial and primary prevention strategies including lifestyle modifications (dietary counseling for low total and saturated fat and cholesterol, increased fruits/vegetables/fiber, reduced sodium and sugar-sweetened beverages; at least 60 minutes daily of moderate to vigorous physical activity; limiting screen time to <2 hours/day), staged weight management protocols, and pharmacologic therapy for persistent hypertension (diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, beta-adrenergic blockers)

O

Outcome

Prevention and reduction of cardiovascular disease risk factors (adiposity/BMI, systolic and diastolic blood pressure, total cholesterol, LDL-C, HDL-C, triglycerides, insulin resistance, left ventricular hypertrophy) and subclinical atherosclerosis (carotid intima-medial thickness, arterial stiffness)

Limitations

Evidence on the effectiveness of long-term dietary intervention for reduction of CVD risk factors in children is limited.
The exact dose (duration and intensity) of physical activity required to modify cardiovascular risk factors in children and youth remains to be clarified.
No valid and reliable instruments are currently available for assessment of physical activity in pediatric primary care settings.
No multi-decade, longitudinal population-based studies or randomized controlled trials have demonstrated that reducing atherogenic lipids in early life prevents incident CVD in adulthood.
There are no studies documenting the comparative effectiveness of one antihypertensive agent or class over another in children and adolescents.
Evidence on the effectiveness of long-term dietary intervention for reduction of risk factors for CVD in children is limited.
The dose (duration and intensity) of physical activity required to modify cardiovascular risk factors in children and youth remains to be clarified.
There are no studies that document comparative effectiveness of one antihypertensive pharmacologic agent or class of agents over another in children.
No multi-decade, longitudinal population-based studies have been conducted linking absolute levels of lipids and lipoproteins in childhood to incident CVD in adult life, and no randomized controlled trials have demonstrated that reducing atherogenic lipids and lipoproteins in early life prevents CVD in adulthood.

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Implication

This report synthesizes current evidence and clinical recommendations demonstrating that atherosclerosis begins in childhood and emphasizes early lifestyle and clinical interventions in youth to prevent and modify cardiovascular risk factors.

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Cite This Study

Daniels et al. (2011) conducted a review in Cardiovascular disease risk factors in children and adolescents (obesity, hypertension, dyslipidemia, physical inactivity, tobacco use). Primordial and primary prevention strategies (dietary modification, physical activity, weight management, blood pressure control, lipid management, and smoking prevention/cessation) was evaluated on Reduction and prevention of cardiovascular disease risk factors and subclinical atherosclerosis in youth. Integrated family-based lifestyle and clinical interventions in childhood and adolescence can prevent and ameliorate cardiovascular risk factors that track into adulthood.

synapsesocial.com/papers/6af7d261dabe3aae4aca1d75 https://doi.org/10.1161/circulationaha.110.016170

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Reduction of Risk for Cardiovascular Disease in Children and Adolescents

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Reduction of Risk for Cardiovascular Disease in Children and Adolescents

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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