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Guidelines for Preventive Pediatric Cardiology

The American Heart Association has updated a guideline for the prevention of CVD. Table below is a summary that presents goals and recommendations to achieve the goals of reducing risks in children and adolescents identified as at high risk for future CVD.

Risk Identification Treatment Goals Recommendations
Blood Cholesterol


>170 mg/dL is borderline
>200 mg/dL is elevated
>110 mg/dL is borderline
>130 mg/dL is elevated.

<160 mg/dL
(<130 mg/dL is even better)
For patients with diabetes,
LDL-C <100 mg/dL

If LDL-C is above goals, initiate additional therapeutic lifestyle changes, including diet (<7% of calories from saturated fat; <200 mg cholesterol per day), in conjunction with a trained dietitian.
Consider LDL-lowering dietary options (increase soluble fiber by using age [in years] plus 5 to 10 g up to age 15, when the total remains at 25 g per day) in conjunction with a trained dietitian.
Emphasize weight management and increased physical activity.
If LDL-C is persistently above goals, evaluate for secondary causes (thyroid-stimulating hormone, liver function tests, renal function tests, urinalysis).
Consider pharmacologic therapy for individuals with LDL >190 mg/dL with no other risk factors for CVD or >160 mg/dL with other risk factors present (blood pressure elevation, diabetes, obesity, strong family history of premature CVD).
Pharmacologic intervention for dyslipidemia should be accomplished in collaboration with a physician experienced in treatment of disorders of cholesterol in pediatric patients.
Other Lipids and Lipoprotein

>150 mg/dL HDL-C <40 mg/dL

Fasting TG
<150 mg/dL
HDL-C >40 mg/dL

Elevated fasting TG and reduced HDL-C are often seen in the context of overweight with insulin resistance. Therapeutic lifestyle change should include weight management with appropriate energy intake and expenditure. Decrease intake of simple sugars.
If fasting TGs are persistently elevated, evaluate for secondary causes such as diabetes, thyroid disease, renal disease, and alcohol abuse.
No pharmacologic interventions are recommended in children for isolated elevation of fasting TG unless this is very marked (treatment may be initiated at TG >400 mg/dL to protect against postprandial TG of 1000 mg/dL or greater, which may be associated with an increased risk of pancreatitis).
Blood Pressure

Systolic and diastolic pressure >95th percentile for age, sex and height percentile.

Systolic and diastolic blood pressure <95th percentile for age, sex, and height

Promote achievement of appropriate weight.
Reduce sodium in the diet. Emphasize increased consumption of fruits and vegetables.
If BP is persistently above the 95th percentile, consider possible secondary causes (e.g., renal disease, coarctation of the aorta).
Consider pharmacologic therapy for individuals above the 95th percentile if lifestyle modification brings no improvement and there is evidence of target organ changes (left ventricular hypertrophy, microalbuminuria, retinal vascular abnormalities). Start blood pressure medication individualized to other requirements and characteristics of the patient (i.e., age, race, need for drugs with specific benefits).
Pharmacologic management of hypertension should be accomplished in collaboration with a physician experienced in pediatric hypertension.

>85th percentile is at risk of overweight
>90th percentile is overweight

>Achieve and maintain BMI <95th percentile for age and sex

For children who are at risk of overweight (>85th percentile) or obesity (>95th percentile), a weight management program should be initiated with appropriate energy balance achieved through changes in diet and physical activity.
For children of normal height, a secondary cause of obesity is unlikely.
Weight management should be directed at all family members who are overweight, using a family-centered, behavioral management approach.
Weight management should be done in collaboration with a trained dietitian.

Near-normal fasting plasma glucose (<120 mg/dL)
Near-normal HbA1c (<7%) (goals for fasting glucose and HbA1c should take into consideration age and risk of hypoglycemia)

Management of type 1 and type 2 diabetes in children and adolescents should be accomplished in collaboration with a pediatric endocrinologist.
For type 2 diabetes, the first step is weight management with improved diet and exercise.
Because of risk for accelerated vascular disease, other risk factors (e.g., blood pressure, lipid abnormalities) should be treated more aggressively in patients with diabetes.
Cigarette Smoking
Complete cessation of smoking for children and parents who smoke Advise every tobacco user (parents and children) to quit and be prepared to provide assistance with this (counseling/referral to develop a plan for quitting using available community resources to help with smoking cessation).

Pediatric Cardiology for Practitioners 5th Edition by Myung K. Park (Elsivier) 2008

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