The AAP (American Academy of Pediatrics) is the predominant organization that helps pediatricians with guidelines that define best practice based on literature (journals) and expert opinions. Last spring, the AAP published guidelines on improving the cardiovascular health of our children and ultimately the adult population. This article addresses some of the recommendations made in the guidelines. One important change is a recommendation that children 9-11 and 17-21 have their cholesterol levels checked routinely.
Cardiovascular (heart and blood vessel) disease is the leading cause of death in the United States. Although we do not see the disease in children, if we start to work on children’s cardiovascular health, we will slow down the process of the disease when they are adults. The AAP put together a panel of experts to create guidelines for the prevention of heart and vascular disease. The goal is to promote heart and blood vessel health, identify and prevent the risk factors that lead to heart and blood vessel disease, and help manage these risk factors. The recommendations are based on data from over 1,000 studies and the consensus from experts when data is lacking.
We know that atherosclerosis, or clogged arteries, is the main cause heart attacks and strokes. (An artery is the tube that brings blood to the body and heart). We also know that there are certain risk factors related to how our bodies work and how we treat our bodies that contribute to the development of atherosclerosis. The greater the number and severity of risk factors, the worse the atherosclerosis will likely be. The major risk factors include:
- Non-healthy diet
- High blood pressure
- Blood cholesterol levels
- Tobacco use
- Family history of early heart attacks (men before 55 and women before 65)
During checkups, the AAP now recommends that pediatricians pay attention to this risk factors by:
- Determining family history of heart disease
- Preventing and treating tobacco use
- Paying attention to diet and nutrition
- Monitoring for obesity
- Routinely checking lipid/cholesterol levels
- Routinely checking blood pressure after age 3
- Encouraging physical activity
- Checking for diabetes as indicated
- Encouraging fat intake of less than 30 percent and saturated fat intake limited to 7-10 percent
- Decrease sugar sweetened beverages
One striking new recommendation is routine lipid and cholesterol screening for all children aged 9 and 17. In the past we screened only those who had a family history of heart disease. Unfortunately, we missed 30-60 percent of the at-risk children. So now we have more significant screening recommendations. Some of the cholesterol screening recommendations include:
- No one under the age of 2
- Aged 2-8 years: check fasting and if high, check fasting lipid profile two times and average the two values
- Aged 9-11: check everyone non fasting and if high, check fasting lipid profile two times and average the two values
- Aged 12-16: if new evidence of family history arises, check fasting two times and average
- Aged 17-21: check fasting lipid profile two times and average the two values
A lipid profile includes levels of different types of cholesterol because it does matter what type of cholesterol you have in your body. Several facts about the types of cholesterol include:
- HDL (high density lipoprotein cholesterol) is good
- LDL and VLDL (all other cholesterol) is bad
- High triglycerides can be bad but should be measured fasting because these are related to recent fat intake
- Obesity plays a role in cholesterol metabolism because the more obese one is, the more likely he or she has higher non-HDL cholesterol and triglyceride levels.
Treatment for high bad cholesterol includes mainly dietary changes like eating fewer foods with high cholesterol and saturated fats. If you have high bad cholesterol, your provider will recommend dietary changes, refer you to a dietician, or refer you to a cholesterol specialist. If diet management is unsuccessful and the levels are unsafe, then some of the medicines used in adults can be tried if the cholesterol levels are severe enough.
Routine visits to the primary care provider for blood pressure checks and cholesterol screening, attention to diet and nutrition, exercise, and attention to weight management can have a great impact on the future well being of your children. Talk with your child’s physician on how you can partner together to create healthy habits for your children.
For more information and resources, visit www.aap.org or http://www.nhlbi.nih.gov/guidelines/cvd_ped/summary.htm
By Dr. David Hartenbach, Esse Health Pediatrician
Esse Health Creve Coeur Pediatrics
11630 Studt Avenue, Suite 200
Creve Coeur, MO 63141