February 25, 2019
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AHA: Obesity increases risk for premature heart disease in children

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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.

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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.