Prevention of Future Cardiovascular Disease in High-Risk Pediatric Patients

Abstract

Over the past 3 decades, childhood obesity has increased dramatically and has been deemed an epidemic by the Centers for Disease Control and Prevention.1 The 2002 National Health and Nutrition Examination Survey reported that the prevalence of overweight and obese children aged 6 to 19 years was 31%, a 45% increase from the previous survey.2 Obesity has been linked to comorbid conditions in children, including type 2 diabetes mellitus, hypertension, and hyperlipidemia.3,4 There is widespread concern that the increasing prevalence of these cardiovascular risk factors in the pediatric population will lead to a dramatic rise in adult cardiovascular disease. However, because of the difficulty associated with conducting long-term longitudinal studies necessary to validate these concerns, most investigations in this area, to date, have focused on the relationship between childhood obesity and surrogate markers of cardiovascular disease. The presence of obesity, hyperlipidemia, and hypertension in childhood has been linked to elevated left ventricular mass and carotid intima-media thickness, as well as peripheral endothelial dysfunction.4–7 These have been shown to be markers of cardiovascular risk in adult patients.8–10 Other studies have shown that childhood obesity and associated comorbidities are related to early atherosclerosis. In an autopsy series, Berenson et al11 showed that the presence and severity of coronary atherosclerotic plaque in asymptomatic young adults was significantly related to the number of risk factors present, including higher body mass index, hypertension, and hyperlipidemia. A recent Danish study is the first to demonstrate a link between childhood obesity and cardiovascular events in adulthood. Baker et al12 identified 275 835 adults for whom there was information on childhood body mass index and found that childhood body mass index was significantly associated with coronary artery events and death in adulthood.12 In light of these findings, the American Academy …