American Heart Association guidelines for prevention of pediatric cardiovascular disease

Abstract

To the Editor: I would appreciate some clarification of the American Heart Association guidelines for primary prevention of atherosclerotic cardiovascular disease beginning in childhood.1.Kavey R. Daniels S. Lauer R. Atkins D. Hayman L. Taubert K. American Heart Association guidelines for primary prevention of atherosclerotic cardiovascular disease beginning in childhood.J Pediatr. 2003; 142: 368-372Abstract Full Text Full Text PDF PubMed Scopus (129) Google Scholar The recommendation is that screening fasting lipids should be done in children older than 2 years with a family history of dyslipidemia or premature cardiovascular disease. Children 2 to 4 years old tend to be picky eaters and have a limited intake. As long as the parents are instructed to provide a proper diet, what is gained by obtaining lab numbers except traumatizing this age group with a venipuncture? In the report, a total cholesterol >170 mg/dL is considered borderline and >200 mg/dL is elevated. Are you recommending we screen with total cholesterol rather than with lipoproteins? Would it be more expedient to screen with the latter? You also recommend averaging three fasting lipid profiles before proceeding to therapy. In my experience, parents (especially working parents) would find many lab visits onerous in terms of time as well as trauma to the child. Why would one measurement, or at the most two, not be acceptable? Also, is there a total cholesterol level, above which is a risk factor itself? A low-density lipoprotein-cholesterol (LDL-C) level >110 mg/dL is listed as borderline and >130 mg/dL is considered elevated (Table II from original report). Yet in Table III, the goal for LDL-C is <160 mg/dL, and <130 mg/dL is even better. Why are such high LDL-C levels acceptable goals when there is a level of concern with LDL-C levels >110? Should we therefore aim to reduce an LDL-C of >130 mg/dL to <110 mg/dL? What do we advise parents to do for children with an LDL-C between 110 and 130 mg/dL? Is this range acceptable? The American Association of Pediatrics guidelines consider an LDL-C of >110 mg/dL to be borderline, and >130 mg/dL as significantly elevated, each with an associated treatment plan.2.Klish W. Baker S. Cochran W. Flores C. Georgieff M. Jacobson M. et al.American Academy of Pediatrics Committee On Nutrition Cholesterol in Childhood.Pediatrics. 1998; 101: 141-147PubMed Google Scholar Should we now ignore therapy for children with LDL-C levels between 110 and 129 mg/dL? Thank you for your response.