Pediatric Preventive Cardiology: Atherosclerosis and Coronary Heart Disease

Abstract

Pediatric preventive cardiology has as one of its goals, the reduction in incidence and severity of cardiovascular disease in adults by the promotion of prudent life-styles in children and adolescents. Few would find fault with this goal, yet the "best" approach and strategy to reduce atherosclerosis and coronary heart disease has been the source of controversy.1-4 The recently published National Institutes of Health Consensus Conference Statement on lowering blood cholesterol to prevent heart disease has summarized the literature relating blood cholesterol and heart disease.5 The strategies recommended include: (1) dietary changes to reduce total dietary fat, saturated fat, and dietary cholesterol consumption in everyone older than 2 years of age, (2) universal blood cholesterol screening for all adults older than 18 years of age, (3) more intensive diet therapy for those with a blood cholesterol level ≥75th percentile, (4) possible addition of drug therapy for individuals whose blood cholesterol levels remain ≥75th percentile despite diet therapy, and (5) in individuals with elevated blood cholesterol levels, emphasis on management of other coronary heart disease risk factors: hypertension, cigarette smoking, diabetes and physical inactivity. The European Atherosclerosis Society has also recently advocated screening the population to find those at high risk (eg, those with an elevated blood cholesterol level in conjunction with population strategies to improve nutrition, eradicate smoking, control hypertension, and promote suitable physical activity.6