In the JournalsPerspective

AHA: Obesity increases risk for premature heart disease in children

Sarah D. de Ferranti
Sarah D. de Ferranti

Children and teenagers with obesity and severe obesity, in addition to other conditions, have an increased risk for premature heart disease, according to a scientific statement from the American Heart Association published in Circulation.

This scientific statement is an update to the previously published scientific statement published by the AHA in 2006.

“Parents need to know that some medical conditions raise the chances of premature heart disease, but we are learning more every day about how lifestyle changes and medical therapies that can lower their cardiovascular risk and help these children live their healthiest lives,” Sarah D. de Ferranti, MD, MPH, chief of the division of cardiology outpatient services at Boston Children’s Hospital and chair of the writing group, said in a press release.

CV risk factors

The scientific statement addresses several traditional CV risk factors that present in childhood such as familial hypercholesterolemia, which can cause premature atherosclerosis and then earlier CV morbidity and mortality. Although this condition is asymptomatic in children, health care providers should follow any clinical suspicions, especially in those with a family history of premature CVD or significant hypercholesterolemia. Assessments should include lipid profiles and genetic testing, according to the scientific statement. Treatment options for children with heterozygous familial hypercholesteremia include adequate physical activity, statins, a smoke-free environment and a diet low in saturated fat and high in fiber.

Obesity has been shown to be associated with coronary and aortic fatty streaks or other atherosclerotic lesions. Health care providers should screen children by calculating BMI and plotting results on growth charts. Once a child is diagnosed with obesity, they should be considered for further screening for CV risk factors. Treatment for obesity should be approached in a graduated and multimodal manner, according to the scientific statement.

Patients with type 1 or type 2 diabetes have an increased prevalence of macrovascular disease including stroke, MI and peripheral vascular disease. Other CVD risk factors associated with diabetes accelerates the diagnosis of atherosclerosis, according to the scientific statement. Although complications related to macrovascular disease are unlikely to occur in children, subclinical vascular abnormalities seen in adults with clinical CV events have been shown to develop in children. Once diagnosed with diabetes, children should be screened annually for additional CVD risk factors. Glycemic control and reduction CVD risk factors should be the two major approaches for reduction CV risk in children, according to the scientific statement.

Hypertension is another known risk factor for developing atherosclerosis in children and CVD events in adults. Children aged 3 years and older should have their BP measured at all routine health care visits. Once diagnosed, children should be treated with pharmacotherapy and therapeutic lifestyle change modification, according to the scientific statement.

High-risk medical conditions discussed in the scientific statement include chronic kidney disease, childhood cancer and chronic inflammatory diseases such as psoriasis and rheumatoid arthritis.

Congenital heart disease

Congenital heart disease also increases the risk for a CVD event, as those with the condition have functional and structural heart abnormalities make the patient more vulnerable to atherosclerosis. Congenital coronary anomalies in the presence or absence of congenital heart disease can also predispose a patient to the development of premature CVD, according to the scientific statement.

A leading cause of acquired heart disease is Kawasaki disease, which can lead to coronary artery aneurysms in those who are not treated.

Children who undergo heart transplants have an increased risk for cardiac allograft vasculopathy, according to the scientific statement. In addition, these children often have an unbalanced lipid metabolism and should be treated with statin therapy.

“Further research is needed to explore the pathophysiology of atherosclerosis unique to each specific diagnosis, to develop improved methods for assessment of preclinical disease, and to critically evaluate therapeutic interventions,” de Ferranti and colleagues wrote. – by Darlene Dobkowski

Disclosures: de Ferranti reports no relevant financial disclosures. Please see the scientific statement for all other authors’ relevant financial disclosures.

 

Sarah D. de Ferranti
Sarah D. de Ferranti

Children and teenagers with obesity and severe obesity, in addition to other conditions, have an increased risk for premature heart disease, according to a scientific statement from the American Heart Association published in Circulation.

This scientific statement is an update to the previously published scientific statement published by the AHA in 2006.

“Parents need to know that some medical conditions raise the chances of premature heart disease, but we are learning more every day about how lifestyle changes and medical therapies that can lower their cardiovascular risk and help these children live their healthiest lives,” Sarah D. de Ferranti, MD, MPH, chief of the division of cardiology outpatient services at Boston Children’s Hospital and chair of the writing group, said in a press release.

CV risk factors

The scientific statement addresses several traditional CV risk factors that present in childhood such as familial hypercholesterolemia, which can cause premature atherosclerosis and then earlier CV morbidity and mortality. Although this condition is asymptomatic in children, health care providers should follow any clinical suspicions, especially in those with a family history of premature CVD or significant hypercholesterolemia. Assessments should include lipid profiles and genetic testing, according to the scientific statement. Treatment options for children with heterozygous familial hypercholesteremia include adequate physical activity, statins, a smoke-free environment and a diet low in saturated fat and high in fiber.

Obesity has been shown to be associated with coronary and aortic fatty streaks or other atherosclerotic lesions. Health care providers should screen children by calculating BMI and plotting results on growth charts. Once a child is diagnosed with obesity, they should be considered for further screening for CV risk factors. Treatment for obesity should be approached in a graduated and multimodal manner, according to the scientific statement.

Patients with type 1 or type 2 diabetes have an increased prevalence of macrovascular disease including stroke, MI and peripheral vascular disease. Other CVD risk factors associated with diabetes accelerates the diagnosis of atherosclerosis, according to the scientific statement. Although complications related to macrovascular disease are unlikely to occur in children, subclinical vascular abnormalities seen in adults with clinical CV events have been shown to develop in children. Once diagnosed with diabetes, children should be screened annually for additional CVD risk factors. Glycemic control and reduction CVD risk factors should be the two major approaches for reduction CV risk in children, according to the scientific statement.

PAGE BREAK

Hypertension is another known risk factor for developing atherosclerosis in children and CVD events in adults. Children aged 3 years and older should have their BP measured at all routine health care visits. Once diagnosed, children should be treated with pharmacotherapy and therapeutic lifestyle change modification, according to the scientific statement.

High-risk medical conditions discussed in the scientific statement include chronic kidney disease, childhood cancer and chronic inflammatory diseases such as psoriasis and rheumatoid arthritis.

Congenital heart disease

Congenital heart disease also increases the risk for a CVD event, as those with the condition have functional and structural heart abnormalities make the patient more vulnerable to atherosclerosis. Congenital coronary anomalies in the presence or absence of congenital heart disease can also predispose a patient to the development of premature CVD, according to the scientific statement.

A leading cause of acquired heart disease is Kawasaki disease, which can lead to coronary artery aneurysms in those who are not treated.

Children who undergo heart transplants have an increased risk for cardiac allograft vasculopathy, according to the scientific statement. In addition, these children often have an unbalanced lipid metabolism and should be treated with statin therapy.

“Further research is needed to explore the pathophysiology of atherosclerosis unique to each specific diagnosis, to develop improved methods for assessment of preclinical disease, and to critically evaluate therapeutic interventions,” de Ferranti and colleagues wrote. – by Darlene Dobkowski

Disclosures: de Ferranti reports no relevant financial disclosures. Please see the scientific statement for all other authors’ relevant financial disclosures.

 

    Perspective

    The purpose of this statement is to identify to clinicians subsets of pediatric patients with other types of diseases that may be at risk or at high risk for developing atherosclerotic CV diseases. It is looking beyond the traditional patient with hereditary dyslipidemia to those that may have other medical conditions that may cause other risk factors for heart disease or may directly affect the coronary arteries themselves.

    This scientific statement identifies which patients to pay attention to, but it also gives some very detailed information about what risk factors clinicians need to assess for, what are the specific cut points and treatment goals depending on level of risk and how to target for therapeutic lifestyle change and make decisions about whether the patient might need medical therapy for a specific risk factor.

    The writing group was very good about putting in a table which outlined each of these specific conditions, what research is needed in terms of basic, clinical and population-based research. One of the unique things about this paper is that the authors have very clearly outlined what are good ideas for further advancing the level of evidence to support paying attention to some of these problems.

    The authors do point to a lot of relevant guidelines and statements that might be specific to some of these conditions that have been put out by other organizations. The paper also has a table that outlines resources that can be used by practitioners, including things like guidelines and scientific statements, but also points to relevant patient resources usually from disease-specific patient and parent organizations. It gives you much more guidance and points you in the right direction on a lot of these very specific problems.

    This statement highlights a unique opportunity to look beyond the traditional atherosclerotic CV risk factors that we think about in adults and to highlight specific conditions that appear in the pediatric population that also puts children at risk for accelerated atherosclerosis and premature CVD.

    • Brian W. McCrindle, MD, MPH
    • Professor of Pediatrics
      University of Toronto
      Section Head, Preventive Cardiology
      Staff Cardiologist
      Senior Scientist
      Labatt Family Heart Center
      The Hospital for Sick Children, Toronto

    Disclosures: McCrindle reports no relevant financial disclosures.