The American Heart Association has released guidelines on preventing heart disease beginning in childhood. Prevention may include diet changes, physical activity changes and in some cases, drugs for high blood pressure and high cholesterol for children at increased risk.
The new guidelines, presented at the association's annual conference on Cardiovascular Disease Epidemiology and Prevention, are the first to address prevention beginning in childhood.
"There is now quite a large body of evidence documenting pathologic and physiologic changes when hypertension, high cholesterol and diabetes are present in childhood. Because the process of heart disease begins then, prevention should hold the most promise when it is initiated in children," said lead author Dr Rae-Ellen W. Kavey, chair of cardiology at Children's Memorial Hospital, Northwestern University - Feinberg School of Medicine in Chicago.
The paper builds on guidelines to address the risk factors identified in adults and how to approach each of those beginning in childhood.
"These guidelines present a conservative approach in an easy-to-use format identifying risk factors in childhood and safely modifying those identified without harm to the growing child," the authors write.
The guidelines address three areas. The first identifies "health promotion goals" for all children. It recommends that physicians assess diet, tobacco use and physical activity level at every visit. Paediatricians should educate parents to restrict high-fat foods after age two and limit salt and sugar intake. Sedentary time should be reduced, such as limiting children to no more than two hours of television a day.
The second area identifies children and adolescents at high risk for cardiovascular disease by assessing the factors mentioned above plus measuring height, weight, body mass index (BMI) and blood pressure. Physicians should also make regular updates to family medical history and test cholesterol levels in high-risk children. This section identifies those children who should have specific testing and provides normal data to allow physicians to interpret results.
The third area focuses on intervention for children with identified risks. For children and adolescents with abnormal cholesterol, this includes dietary changes to reduce low-density lipoprotein (LDL) - the so-called "bad cholesterol" - and considering cholesterol-lowering drugs for those with a strong family history of premature cardiovascular disease.
For children with blood pressure above the 95th percentile for their age, gender and height, the guidelines suggest restricting sodium (salt), and emphasising weight control. Possible causes for persistent elevated blood pressure such as renal disease should be investigated, and some children may need blood pressure-lowering drugs.
The statement recommends diet and increased physical activity for overweight and obese children. The guidelines suggest that weight management be directed at all overweight family members.
Kavey said: "Paediatricians are well prepared to carry out these recommendations. They should be routinely looking at body weight, charting blood pressure and asking about physical activity in all kids, and specifically measuring cholesterol levels in select children."
The guidelines will be published in the March 25 print issue of Circulation: Journal of the American Heart Association.