Cardiovascular Health In Children Research Articles

Relation to Social Determinants in Cardiovascular Disease Risk Profile: An Alarming View

Globally, Cardiovascular disease (CVD) is one of the major reasons for mortality. Cardiovascular health in children and adults is profoundly affected by the milieu of early life. Currently, CVD is taking a different turn based on social antecedents like poverty, the difference in socio-economic status, gender inequality, being a fluid person, and work life in harmony increases the risk of getting into CVD, that too in vulnerable populations like racial and ethnic minorities, women, the elderly, the chronically ill individual with disabilities, lesbian, gay, bisexual, transgender, queer and racism play a significant role in conditioning disease burden and modulating outcomes of CVD. People with low socioeconomic status increase the hypothalamic pituitary adrenal axis (HPA axis) in the body, due to stress response, and at the end, increased cortisol and sympathetic nervous system activity lead to decreased angiogenic activity. People from low socioeconomic backgrounds, loneliness, and social isolation in many cases like racism, ethnic minorities, children, women, elderly, and chronically ill individuals with disabilities, are exposed to constant stress because of a lack of their fundamental needs. The wider introduction of universal screening for social factors that impact cardiac health will help to identify children and families at risk. Hence,aggressive screening tests beginning at an early age will be beneficial for early detection and treatment. Healthcare professionals need to pay attention to promotinghealth education and awareness aids to decrease CVD-associated mortality.

Maternal Seafood Consumption during Pregnancy and Cardiovascular Health of Children at 11 Years of Age.

Nutrition is critical during pregnancy for the healthy growth of the developing infant, who is fully dependent on maternal dietary omega-3 supply for development. Fatty fish, a main dietary source of omega-3, is associated with decreased cardiovascular risk in adults. We conducted a longitudinal study based on a mother-offspring cohort as part of the project Infancia y Medio Ambiente (INMA) in order to assess whether fish intake during pregnancy relates to cardiovascular health in children. A total of 657 women were included and followed throughout pregnancy until birth, and their children were enrolled at birth and followed up until age 11-12. A semi-quantitative food frequency questionnaire was used to assess the daily intake of foods during the 1st and 3rd trimesters of pregnancy. Cardiovascular assessments included arterial stiffness (assessed by carotid-femoral pulse wave velocity [PWV]) and retinal microcirculation (photographic assessment of central retinal arteriolar and venular equivalent [CRAE and CRVE]). The association between maternal fish consumption and cardiovascular outcomes of offspring at 11 years of age was evaluated using multivariable linear regression models. There were no statistically significant differences in any cardiovascular endpoint in children whose mothers had a higher fish consumption during pregnancy compared to those with a lower fish consumption. We found a slightly higher PWV (β = 0.1, 95% CI = 0.0; 0.2, p for trend = 0.047) in children whose mothers had a higher consumption of canned tuna during the 1st trimester of pregnancy. Fish intake during pregnancy was found to be unrelated to the offspring's cardiovascular health at 11 years of age. The beneficial cardiovascular effects of fish consumption during pregnancy on the offspring are still inconclusive.

Abstract MP76: Street View Greenspace Exposures and Cardiovascular Health Among Children - Evidence From Project Viva

Introduction: Research on greenspace and cardiovascular health (CVH) in children is limited, and most previous studies rely on coarse satellite-based measurements of greenspace, which do not capture exposure as individuals experience it. Street View imagery (SVI) enables measurement of greenspace from a ground-level perspective and captures specific elements of greenspace that may be most relevant to health. This study aimed to examine associations of SVI-based greenspace with CVH in children in Project Viva, an eastern Massachusetts-based cohort. Methods: Using data from 1,163 children, we applied deep learning segmentation algorithms to SVI from 2007-2010 to derive metrics of greenspace (%of trees, or grass) within a 500m radius of participants’ residential addresses obtained during mid-childhood (mean age 7.9y). At mid-childhood and early adolescence (mean age 13.2y), we calculated CVH scores (range 0-100 units; higher scores represent better CVH) using the American Heart Association’s Life’s Essential 8 algorithm, based on 4 biomedical measures (body mass index, blood lipids, blood glucose, and blood pressure) and 4 behavioral measures (heart healthy levels of diet, physical activity, avoidance of nicotine, and sleep). Using linear regression, we examined associations of mid-childhood SVI-based greenspace metrics with mid-childhood (cross-sectional) and early adolescence (longitudinal) CVH scores, adjusting for child’s sex, race and ethnicity, and age at outcome, as well as an index score of socioeconomic status comprising individual and neighborhood metrics. Results: Among the 1163 participants, 65% were non-Hispanic White and 49% were female. The mean (SD) LE8 score was 83.3 (8.0) in mid-childhood and 81.7 (8.9) in early adolescence. In the unadjusted models, a higher %trees and grass per SD, as measured by SVI within children’s residence in mid-childhood, was associated with a higher overall CVH score (β 1.63 [95%CI: 0.93, 2.33] for trees; β 1.10 [95%CI: 0.36, 1.83] for grass). In longitudinal analyses, the results were similar (β 1.69 [95%CI: 0.87, 2.52] for trees; β 0.82 [95%CI: -0.01, 1.64] for grass). In fully-adjusted analyses, the cross-sectional and longitudinal results for %trees and grass were attenuated and not statistically significant. However, when CVH scores were disaggregated by behavioral and biomedical sub-scores, %trees was positively associated with behavioral sub-scores in cross-sectional fully-adjusted analyses at mid-childhood (β 0.89 [95%CI: 0.32, 1.46]). Conclusion: Among participants in Project Viva, SVI-based metrics of greenspace exposure in mid-childhood were cross-sectionally associated with behavioral factors promoting higher CVH. Greenspace may hold promise for improving children’s CVH through the behavioral pathway and should be considered in future health-promotion efforts.

Abstract 26: Types of Adverse Childhood Experiences and Association With Sleep Duration in Children: Analysis of 2020-2021 National Survey of Children’s Health

Background: The number of adverse childhood experiences (ACEs) is associated with suboptimal sleep duration in children; however, the differential association of types of ACEs with sleep duration in youth is unknown. Given the known associations of both ACEs and sleep duration with cardiovascular health, such an investigation will provide insights for targeted clinical intervention. Objective: We investigated the most frequently reported ACE types and the association between each type of ACE and sleep duration among U.S. children aged 6-17 years. Methods: We used data from the 2020-2021 National Survey of Children’s Health, the most recent publicly available dataset. Parents or guardians were asked whether their child had ever experienced ten different types of ACEs. Multinomial logistic regression was used to assess the association of sleep duration with each of ACEs. We used the American Heart Association (AHA) Life Essential 8 scoring algorithm to calculate scores for sleep duration (range 0 [lowest] to 100 [highest]). Participants were categorized into three subgroups: (1) meeting age-appropriate optimal sleep duration; (2) ≥1-<2 hour below or ≥ 1 hour above optimal sleep duration; and (3) ≥ 2 hours below optimal sleep duration. Analyses controlled for child’s sex, age, race/ethnicity, household poverty level, regular bedtime, physical activity, and caregiver’s level of education. Results: Parental divorce was the most frequently reported ACE (28.1%) followed by financial hardship (12.9%) and drug abuse (10.1%) among U.S. children aged 6 to 17 years. Adjusting for covariates, 5 of 10 ACEs (parental divorce, parental imprisonment, domestic violence, living with someone who had a problem with alcohol or drugs, unfair treatment because of their sexual orientation or gender identity) were significantly associated with suboptimal sleep category 2. All 10 ACEs were significantly associated with suboptimal sleep category 3. Conclusions: These findings support that ACE type is differentially associated with suboptimal childhood sleep duration and suggests that certain traumatic events experienced during childhood could amplify the adverse effects of poor sleep on cardiovascular health. Healthcare providers should consider screening for ACE type concurrent with sleep duration to better understand aspects contributing to cardiovascular health in childhood.

Abstract P411: Child Opportunity and Behavioral Cardiovascular Health in Youth: The Young Hearts Study

Background: Low cardiovascular health (CVH) in childhood is linked to risk of cardiovascular events in adulthood in the US. Relationships between neighborhood characteristics could be important for CVH in children, as appears to be the case in adults. We sought to assess such associations, representing neighborhood characteristics by the Child Opportunity Index (COI) and using a composite behavioral CVH score in youth. Methods: We used baseline data from the Young Hearts study, which is studying CVH trajectories of children ages 0-20. We linked children’s addresses to the COI, with domains encompassing: (1) social and economic, (2) health and environmental, and (3) educational opportunity. CVH behaviors were defined using the Life’s Essential 8 framework and included: self-reported diet, physical activity, nicotine exposure, and sleep. Linear regression models assessed the association between COI and overall and component behavioral CVH scores after adjustment for child demographics, family SES, and moves in the last year. Overall CVH scores comprised of the mean value of 4 behavior-specific scores (each 0-100 points). Results: Participants (N=2202) were 9.5±5.4 years old; 46.3% were female, and 47.05% identified as non-Hispanic White, 25.3% as Hispanic, and 17.9% as non-Hispanic Black. Compared with high (favorable) COI, individuals with low COI had a 2.15-point lower (worse) mean behavioral CVH score (p=0.003); however, those with moderate COI did not have significantly lower mean scores. The pattern for the education domain was similar but weaker. In the social and economic domain, those with low and moderate COI both had lower behavioral CVH scores than those with high COI. The health and environment domain was not independently associated with CVH. Of individual metrics, only sleep scores (beta=68.32, p=0.005) were independently associated with COI after adjustment. Conclusion: COI, especially social and economic factors, were associated with overall behavioral CVH among a diverse population of children.

Abstract P445: Associations of Homeownership and Overcrowding Conditions With Cardiovascular Health Among Diverse U.S. Children and Adults

Background: We hypothesized that children and adults living in rented and overcrowded houses have lower cardiovascular health (CVH), as measured by Life Essential 8 (LE8), a powerful predictor of CVD. We evaluated if this association varied by race/ethnicity. Methods: This cross-sectional study used pooled data from the National Health and Nutrition Examination Survey 2013-2018 (NHANES). LE8 scores (range 0-100) were estimated following age-specific criteria with all metrics available for each age group. Overcrowding was defined as two or more persons per room, per Census Bureau’s criteria. Multivariable linear regressions estimated the association of overcrowding and homeownership (v. rental status) with CVH, for children (aged 2-19) and adults separately. Racial/ethnic differences were examined using interaction terms. Weighted models adjusted for the complex survey design and the following covariates: age, sex, race/ethnicity, insurance status, country of birth, and self or parental education and marital status. Results: Homeownership was associated with a 1-point higher CVH among children ( p =0.02), except for Black children, who had higher CVH when they lived in rented homes (86.51 for renters vs. 85.46 for homeowners). Among adults, homeownership was associated with 2.4 points higher CVH (p=0.008). An interaction showed that for Black and Latinx adults, homeownership was associated with lower CVH than renters (MD=-3.30, p= 0.004 for Black and -2.91, p = 0.006 for Latinx). Overcrowding was not associated with child CVH ( p =0.57). Among adults, and interaction showed that living in overcrowded houses was associated with lower CVH for Black (MD= -2.47, p=0.006) and Latinx adults (MD= -3.53, p <0.001). Conclusions: Overcrowded housing and homeownership are associated with CVH in children and adults, but relationships vary by race/ethnicity. Findings underscore the need to better understand how housing conditions influence CVH disparities and advocate for affordable housing for all.

Abstract P372: Behavioral Cardiovascular Health in Children With Chronic Conditions

Background: A quarter of children in the United States have at least one chronic condition which translates to worse health than their peers. However, there is little information about cardiovascular health (CVH) among children with chronic conditions. Methods: We used data from the Young Hearts study, an ongoing longitudinal cohort of CVH trajectories in youth aged 0-20 years. Parents (and children aged 12+ years) completed surveys on CVH behaviors, medical history, and social context. We included children with complete baseline data. Participants were categorized as having at least one self-reported chronic condition or no chronic condition. We calculated CVH using the behavioral components of the American Heart Association Life’s Essential 8 (diet, physical activity, nicotine exposure, sleep). Each component was scored from 0 (most adverse) to 100 (ideal) and averaged to create a composite behavioral (b) CVH score. We used linear regression to assess the association between chronic condition status (any, none) and bCVH score, adjusting for age, sex, race, ethnicity, insurance type, and household income. Results: We identified 1138 children with at least one chronic condition and 1406 children without any chronic conditions. Among those with chronic conditions, the most common were heart disease (14.9%), asthma (11.2%), and vision problems/blindness (9.7%). In fully adjusted models (Table), we found individuals with any chronic condition had a 1.3 point lower (95% CI -2.5, -0.2) bCVH score on average. Children with chronic conditions had lower (less favorable) scores for sleep (-4.2; 95% CI -7.1, -1.4) and physical activity (-3.7; 95% CI -6.3, -1.2) compared to their peers with no chronic conditions, but a higher (more favorable) nicotine exposure score (1.4; 95% CI 0.5, 2.4). Conclusion: As a group, children with chronic conditions had worse bCVH scores than their peers without chronic conditions. Further research is needed to understand these differences and support CVH promotion in children with chronic conditions.

Optimizing Cardiovascular Health in Childhood: Challenges and Opportunities.

Optimizing Cardiovascular Health in Childhood: Challenges and Opportunities.

2 Association between HDP and GDM and Child Cardiovascular Health in Early Adolescence

2 Association between HDP and GDM and Child Cardiovascular Health in Early Adolescence

Urban greenspaces and child blood pressure in China: Evidence from a large population-based cohort study

BackgroundWith the world's population steadily shifting toward urban living, children's engagement with the natural environment seems to be diminishing. This raises significant concerns about the influence of urban greenspaces on the cardiovascular health of children. ObjectiveTo assess the association between urban greenspaces exposure and blood pressure (BP) in Chinese primary schoolchildren. MethodsThis prospective cohort study used data from the Children's growth environment, lifestyle, physical, and mental health development (COHERENCE) project in Guangzhou, China. Participants included 164,853 primary schoolchildren starting from 2016/17 to 2019/20 academic year. We assessed the surrounding greenspaces at home and school by using Sentinel-2 satellite data on the normalized difference vegetation index. Prehypertension and hypertension status were defined with BP above 90th to less than the 95th percentile, at or above the 95th percentile, respectively. The association of surrounding greenness with children's BP levels and risk of prehypertension/hypertension were examined using linear mixed-effects models and Cox proportional hazards model. ResultsAmong 164,853 eligible children aged 7.21 (0.74) years, 89,190 (54.1%) were boys. Our results showed that average systolic and diastolic BP increased by 0.48 and 0.42 standard deviations, respectively, over the 3-year follow-up. We identified 23,225 new cases of prehypertension and 35,067 of hypertension status. An interquartile range increase both in home-, school- and home-school NDVI100m was significantly associated with a reduction of 0.018–0.037 in BP z-scores and a 2.7%–7.6% lower risk of hypertension. Additionally, family socioeconomic status modified the impact of home-school greenness on BP levels. Air pollution exhibited mediating effects solely in school-greenness-BP associations, while physical activity and children's BMI mainly mediated the relationships between home-greenness and BP. ConclusionThe findings of this large cohort study suggest that surrounding greenspaces are associated with lower BP levels and a decreased risk of prehypertension and hypertension in Chinese schoolchildren.

Rationale and design of the Children's Oncology Group study AAML1831 integrated cardiac substudies in pediatric acute myeloid leukemia therapy.

Pediatric acute myeloid leukemia (AML) therapy is associated with substantial short- and long-term treatment-related cardiotoxicity mainly due to high-dose anthracycline exposure. Early left ventricular systolic dysfunction (LVSD) compromises anthracycline delivery and is associated with inferior event-free and overall survival in de novo pediatric AML. Thus, effective cardioprotective strategies and cardiotoxicity risk predictors are critical to optimize cancer therapy delivery and enable early interventions to prevent progressive LVSD. While dexrazoxane-based cardioprotection reduces short-term cardiotoxicity without compromising cancer survival, liposomal anthracycline formulations have the potential to mitigate cardiotoxicity while improving antitumor efficacy. This overview summarizes the rationale and methodology of cardiac substudies within AAML1831, a randomized Children's Oncology Group Phase 3 study of CPX-351, a liposomal formulation of daunorubicin and cytarabine, in comparison with standard daunorubicin/cytarabine with dexrazoxane in the treatment of de novo pediatric AML. Children (age <22 years) with newly diagnosed AML were enrolled and randomized to CPX-351-containing induction 1 and 2 (Arm A) or standard daunorubicin and dexrazoxane-containing induction (Arm B). Embedded cardiac correlative studies aim to compare the efficacy of this liposomal anthracycline formulation to dexrazoxane for primary prevention of cardiotoxicity by detailed core lab analysis of standardized echocardiograms and serial cardiac biomarkers throughout AML therapy and in follow-up. In addition, AAML1831 will assess the ability of early changes in sensitive echo indices (e.g., global longitudinal strain) and cardiac biomarkers (e.g., troponin and natriuretic peptides) to predict subsequent LVSD. Finally, AAML1831 establishes expert consensus-based strategies in cardiac monitoring and anthracycline dose modification to balance the potentially competing priorities of cardiotoxicity reduction with optimal leukemia therapy. This study will inform diagnostic, prognostic, preventative, and treatment strategies regarding cardiotoxicity during pediatric AML therapy. Together, these measures have the potential to improve leukemia-free and overall survival and long-term cardiovascular health in children with AML. Clinical trial registration: https://clinicaltrials.gov/, identifier NCT04293562.

Altered gut microbiome associated with metabolic-associated fatty liver disease in Chinese children

Limited studies have investigated the association between gut microbiota and metabolic dysfunction-associated fatty liver disease (MAFLD) in children and adolescents. We aimed to identify differences in gut microbiota composition and diversity between children with MAFLD and healthy counterparts. Data were collected from a nested case-control study (October to December, 2021) of the "Huantai Childhood Cardiovascular Health Cohort Study" in Huantai County, Zibo City, China. The study included 52 children aged 5-11 years with new-onset MAFLD and 52 healthy children matched by age and sex. Stool samples were collected and analyzed using 16S rRNA gene sequencing. Shannon index and Chao index were used to assess the α diversity of gut microbiota and Principal coordinates analysis (PCoA) was performed to evaluate β diversity between the two groups. The differences in the relative abundance of gut microbiota between MAFLD group and control group were compared by the Wilcoxon rank-sum test after false discovery rate (FDR) correction. Additionally, the gut-microbial metabolic pathways were identified using the phylogenetic investigation of communities by reconstruction of unobserved states (PICRUSt). We found that children with MAFLD had significant different gut microbiota composition and reduced α diversity compared with the control group. PCoA showed that the two groups can be significantly distinguished based on the unweighted unifrac distance algorithm. Gut microbiota at the phylum level such as Verrucomicrobia and Desulfobacterial, genus level such as Blautia, Lachnospiraceae_NK4A136_group, Coprococcus, Erysipelotrichaceae_UCG-003, UCG-002 and Akkermansia, and species level such as Bifidobacterium_longum abundances were significantly decreased in children with MAFLD compared with that in children without MAFLD. Notably, the abundance of these bacteria were found to be associated with HDL-C, SBP, DBP, WC, BMI, etc. In addition, our analysis of gut-microbial metabolic pathways identified differences in carbohydrate transport and metabolism, as well as amino acid transport and metabolism between the two groups. Significant differences in gut microbiota composition are observed between children with and without MAFLD, which indicate that gut microbiota may be a potential contributor to the development of MAFLD in childhood.

Validation of "Life's Essential 8" Metrics With Cardiovascular Structural Status in Children: The PROC Study in China.

Background Life's Essential 8 (LE8) metrics for cardiovascular health (CVH) aid primordial prevention in US populations. Methods and Results We conducted a child cohort study (PROC [Beijing Child Growth and Health Cohort]) with baseline (2018-2019) and follow-up (2020-2021) assessments, enrolling disease-free 6- to 10-year-old children from 6 elementary schools in Beijing. We collected LE8-assessed components via questionnaire surveys and 3 cardiovascular structural parameters by 2-dimensional M-mode echocardiography: left ventricular mass (LVM), LVM index, and carotid intima-media thickness. Compared with 1914 participants (mean age, 6.6 years) at baseline, we saw lower mean CVH scores at follow-up (n=1789; 8.5 years). Among LE8 components, diet presented the lowest perfect-score prevalence (5.1%). Only 18.6% of participants had physical activity ≥420 min/wk, 55.9% had nicotine exposure, and 25.2% had abnormal sleep duration. Prevalence of overweight/obesity was 26.8% at baseline and 38.2% at follow-up. We noted optimal blood lipid scores in 30.7%, while 12.9% of children had abnormal fasting glucose. Normal BP was 71.6% at baseline and 60.3% at follow-up. LVM (g), LVM index (g/m2.7), and carotid intima-media thickness (mm) were significantly lower in children with high (56.8, 33.2, 0.35) or moderate CVH scores (60.6, 34.6, 0.36), compared with children with low CVH scores (67.9, 37.1, 0.37). Adjusting for age/sex, LVM (β=11.8 [95% CI, 3.5-20.0]; P=0.005), LVM index (β=4.4 [95% CI, 0.5-8.3]; P=0.027), and carotid intima-media thickness (β=0.016 [95% CI, 0.002-0.030]; P=0.028) were higher in the low-CVH group. Conclusions CVH scores were suboptimal, declining with age. LE8 metrics indicated worse CVH in children with abnormal cardiovascular structural measurements, suggesting the validity of LE8 in assessing child CVH. Registration URL: https://www.chictr.org.cn/index.html; Unique identifier: ChiCTR2100044027.

Introduction to the Compendium on Early Cardiovascular Disease.

Introduction to the Compendium on Early Cardiovascular Disease.

Life Course Cardiovascular Health: Risk Factors, Outcomes, and Interventions.

Since it was first defined by the American Heart Association in 2010, cardiovascular health (CVH) has been extensively studied across the life course. In this review, we present the current literature examining early life predictors of CVH, the later life outcomes of child CVH, and the relatively few interventions which have specifically addressed how to preserve and promote CVH across populations. We find that research on CVH has demonstrated that prenatal and childhood exposures are consistently associated with CVH trajectories from childhood through adulthood. CVH measured at any point in life is strongly predictive of future cardiovascular disease, dementia, cancer, and mortality as well as a variety of other health outcomes. This speaks to the importance of intervening early to prevent the loss of optimal CVH and the accumulation of cardiovascular risk. Interventions to improve CVH are not common but those that have been published most often address multiple modifiable risk factors among individuals within the community. Relatively few interventions have been focused on improving the construct of CVH in children. Future research is needed that will be both effective, scalable, and sustainable. Technology including digital platforms as well as implementation science will play key roles in achieving this vision. In addition, community engagement at all stages of this research is critical. Lastly, prevention strategies that are tailored to the individual and their context may help us achieve the promise of personalized prevention and help promote ideal CVH in childhood and across the life course.

The number of metabolic syndrome risk factors predicts alterations in gut microbiota in Chinese children from the Huantai study

BackgroundEvidence on the effect of gut microbiota on the number of metabolic syndrome (MetS) risk factors among children is scarce. We aimed to examine the alterations of gut microbiota with different numbers of MetS risk factors among children.MethodsData were collected from a nested case–control study at the baseline of the Huantai Childhood Cardiovascular Health Cohort Study in Zibo, China. We compared the differences in gut microbiota based on 16S rRNA gene sequencing among 72 children with different numbers of MetS risk factors matched by age and sex (i.e., none, one, and two-or-more MetS risk factors; 24 children for each group).ResultsThe community richness (i.e., the total number of species in the community) and diversity (i.e., the richness and evenness of species in the community) of gut microbiota decreased with an increased number of MetS risk factors in children (P for trend < 0.05). Among genera with a relative abundance greater than 0.01%, the relative abundance of Lachnoclostridium (PFDR = 0.009) increased in the MetS risk groups, whereas Alistipes (PFDR < 0.001) and Lachnospiraceae_NK4A136_group (PFDR = 0.043) decreased in the MetS risk groups compared to the non-risk group. The genus Christensenellaceae_R-7_group excelled at distinguishing one and two-or-more risk groups from the non-risk group (area under the ROC curve [AUC]: 0.84 − 0.92), while the genera Family_XIII_AD3011_group (AUC: 0.73 − 0.91) and Lachnoclostridium (AUC: 0.77 − 0.80) performed moderate abilities in identifying none, one, and two-or-more MetS risk factors in children.ConclusionsBased on the nested case–control study and the 16S rRNA gene sequencing technology, we found that dysbiosis of gut microbiota, particularly for the genera Christensenellaceae_R-7_group, Family_XIII_AD3011_group, and Lachnoclostridium may contribute to the early detection and the accumulation of MetS risk factors in childhood.

Updates in the management of pediatric dyslipidemia.

Pediatric dyslipidemias increase the risk of atherosclerosis and clinical cardiovascular disease and are the leading cause of morbidity and mortality. Lifestyle modifications and pharmacotherapies have measurably improved abnormal lipids and reduced cardiovascular events. The review will focus on current standards of care and investigative medications with the potential to improve cardiovascular health in children and adults. Lifestyle interventions and statins remain cornerstones in the treatment of pediatric hyperlipidemias. Bile acid sequestrants and ezetimibe continue to be used in the pediatric population as well. In recent years, successful clinical trials have approved use of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors in children with familial hypercholesterolemia. Use of angiopoietin-like protein 3 (ANGPTL3) inhibitors is also promising as it causes marked improvement in low-density lipoprotein cholesterol with safe side effect profiles. Additional medications undergoing pediatric clinical trials include inclisiran, bempedoic acid, and lomitapide. Recent advances in pharmacotherapy, especially for treatment of familial hypercholesterolemia, greatly impact treatment of dyslipidemias in children. Despite the overall progress in the development of these medications, therapies targeted towards treating hypertriglyceridemia have lagged behind. Continuing research for the treatment of pediatric dyslipidemias remains an important endeavor to reduce the risk of atherosclerosis and future cardiovascular events in children.

Consumption of very low-mineral water may threaten cardiovascular health by increasing homocysteine in children.

Homocysteine (Hcy) is a critical factor for cardiovascular injury, and the elevation of Hcy in children will inevitably increase the risk of cardiovascular disease in adulthood. This study explored the effect of very low-mineral water on children's Hcy and cardiovascular health. This was a retrospective cohort study that recruited two groups of 10-13-year-old children who had consumed direct drinking water (DDW) in school for 4 years. The control group (NW) (119 boys, 110 girls) consumed normal DDW (conductivity 345 μs/cm). The very low-mineral water consumption group (VLW) (223 boys, 208 girls) consumed very low-mineral DDW (conductivity 40.0 μs/cm). Serum Hcy, Hcy metabolites, cofactors of Hcy metabolism, and cardiovascular biomarkers were assessed and standardized by age- and sex-specific Z-scores, and the differences between the two groups were analyzed with independent t-test. The relationships between Hcy metabolism biomarkers and key factors, cardiovascular biomarkers, serum Ca, and mineral intake were analyzed with linear regression. Compared with the NW group, the VLW group had significantly higher serum Hcy, Apo-B, Apo-B/A1, and oxLDL, and lower serum 1,25,(OH)2D3, vitamin B6 and B12, 5-methyltetrahydrofolate, and Apo-A1. Serum Hcy was positively associated with serum Apo-B and Apo-B/A1, and negatively associated with Ca intake from water and serum 1,25,(OH)2D3. This study suggested that drinking very low-mineral water may increase Hcy level and oxidative stress, worsen lipid profile, and threaten the cardiovascular system in children. Reducing 1,25,(OH)2D3, and disordering of calcium metabolism might play important roles. This study first established an association between demineralized drinking water and cardiovascular health in children, suggesting a new environmental concern risk to cardiovascular health.

Abstract P132: Application of Life’s Essential 8 to Assess the Status of Cardiovascular Health Among 4-to-6-year-old Children in the Healthy Start Study

Introduction: The American Heart Association recently put forth the Life’s Essential 8 (LE8) scoring system to assess cardiovascular health (CVH) status based on four health factors: body mass index [BMI], fasting glucose, non-high-density-lipoprotein cholesterol, and blood pressure; and four behavioral factors: first- and second-hand nicotine exposure, diet quality, physical activity, and sleep duration. Few studies have applied LE8 to assess CVH in children, and little remains known about concordance in CVH status based on LE8 vs. Life’s Simple 7 (LS7), the prior scoring system that employed different definitions and thresholds for defining CVH. Objectives: (1) Apply LE8 to assess prevalence (%) of low, moderate, high, and optimal CVH in diverse 4-to-6-year old children; (2) Compare concordance in CVH status categories based on LE8 vs. LS7. Hypothesis: Use of LE8 will yield at least 20% prevalence of high and optimal CVH; this prevalence will be higher than estimates based on LS7. Methods: Using data from 305 children in the Healthy Start cohort, we applied the LE8 scoring system to derive a composite CVH score for each child and estimated % low (LE8 CVH score &lt;50 of 100 possible points), moderate (score 50-&lt;80), high (score 80-&lt;100), and optimal CVH (score=100). Next, we applied the LS7 scoring system to estimate % of participants in the same four categories (low CVH: LS7 CVH score &lt;7 of 14 possible points; moderate CVH: score 7-&lt;10.5; high CVH: score 10.5-&lt;14; optimal CVH: score=14). Finally, we assessed concordance in prevalence across CVH status categories for LE8 vs. LS7 using the Wald chi-squared test, and calculated the correlation between continuous CVH scores based on LE8 and LS7. Results: The average age of participants was 4.7±0.6 y. Forty-five percent were female (n=136); 62% identified as white, 23% as Hispanic, and 12% as Black. No children had low or optimal CVH with either scoring system. However, prevalence of high CVH was higher based on LE8 than LS7 (40.6% vs. 33.4%; P &lt;0.0001). Twenty-one percent of participants had high CVH according to both scoring systems. We observed a moderate positive correlation (Pearson R 2 =0.55) between continuous CVH scores for LE8 and LS7. Conclusions: While no participants had low or optimal CVH in Healthy Start during early childhood, LE8 yielded a higher prevalence of high CVH than LS7. Future studies are warranted to assess determinants and consequences of CVH status during this life stage.

Primordial prevention: Reducing consumption of sugar-sweetened beverages in racial/ethnic populations

Beyond pharmacotherapy in adulthood, primordial prevention in United States (U.S.) children and adolescents is needed to avoid the upcoming tsunami of cardiometabolic and cardiovascular disease (CVD). Healthcare disparities were unmasked by the disparate morbidity and mortality of COVID-19 in racial/ethnic populations, especially in persons with obesity, diabetes, and CVD. One potential successful strategic improvement of childhood cardiovascular health is to reduce sugar consumption in early life as CVD is the number one cause of death in patients with Type 2 diabetes (T2D). Furthermore, cardiologists treat more patients with T2D than endocrinologists. This commentary challenges cardiovascular specialists and other clinicians to address the increasing burden of cardiometabolic and CVD in adults, especially in racial/ethnic populations, by supporting primordial prevention in childhood.