A call to action for pediatric cardiologists: CVD prevention begins at childhood
Cardiovascular disease (CVD) is believed to be responsible for one in three deaths around the world.[1] Pediatric cardiologists can help combat this trend by looking for warning signs of CVD in their young patients and collaborating with other physicians, according to a new analysis published in Nature Reviews Cardiology.[2]
“For many decades, the predominant public health and clinical strategy for CVD has focused on the reduction of mortality and morbidity and the prevention of further CVD events once an initial event has occurred,” wrote first author Michael Khoury, MD, a pediatric cardiologist with Stollery Children’s Hospital in Edmonton, Alberta, Canada, and colleagues. “This approach has resulted in a gradual decline in CVD morbidity and mortality for >40 years, although perhaps a plateau is now being reached. However, the prevalence of atherosclerotic CVD (ASCVD) risk factors responsible for initiating and driving the atherosclerotic process leading to cardiovascular events remains high, driven by detrimental lifestyle habits, including the overconsumption of nutrient-poor and calorically dense foods, coupled with increasingly sedentary behaviors. These adverse lifestyle habits are exacerbated among young individuals, particularly those living in lower socioeconomic populations.”
Khoury et al. explored this topic in great detail, noting that the progression of ASCVD over time is associated with “recognizable, preventable and treatable cardiovascular risk factors.” Due to a lack of clarity about screening, however, these risk factors are typically identified well into adulthood, when that progression has already been going on for many years.
The group noted that modifiable cardiovascular risk factors include tobacco smoke exposure, blood lipid levels, high blood pressure and obesity. Clinicians who communicate with young patients and their families can make an impact by helping them manage these risk factors. Promoting good cardiovascular health is crucial, the team explained, but not necessarily easy. In fact, Khoury and colleagues recommend working with subspecialty clinics when targeting such risk factors as obesity.
“The implementation and maintenance of sufficient lifestyle changes have remained an important challenge among children and adults given the society-level promotion of sedentary pursuits and diets that are calorically dense, nutritionally deplete and rich in ultra-processed foods,” the authors wrote.
The importance of identifying and managing hypertension in pediatric patients
Hypertension is another critical risk factor cardiologists can help manage in young patients. The group emphasized that multiple studies have confirmed hypertension at a young age is associated with CVD in adulthood.
Blood pressure levels should be tracked for a patient’s entire life, from childhood to adulthood. Also, pediatric hypertension should be treated through the use of lifestyle modifications and, in some cases, antihypertensive therapy.
“Clinical trials in children and adolescents with hypertension have shown that antihypertensive medications are safe and effective, with current guidelines recommending angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, thiazide diuretics and calcium channel blockers as the mainstays of therapy,” the authors wrote.
Targeting diabetes from an early age
Diabetes represents yet another risk factor pediatric cardiologists should be focused on when seeing patients. CVD is a common cause of death among children diagnosed with type 1 diabetes as they get older. These patients can also develop renal disease, hypertension and obesity. Getting these patients the care they need is crucial.
Type 2 diabetes, meanwhile, is a growing concern all over the world. It is being seen in pediatric patients more and more, and screening is recommended in patients who are overweight or obese, have a strong family history or come from an ethnic background associated with high diabetes rates.
How pediatric cardiologists can make a difference
Khoury et al. noted that multiple knowledge gaps remain when it comes to this issue. However, the group wrote that pediatric cardiologists can still make a massive impact by focusing on the risk factors associated with CVD in adulthood. While the specialty primary focuses on “congenital and acquired heart diseases,” the authors wrote that detecting and managing these risk factors should also be treated with a sense of urgency.
“Perhaps the most pressing priority among pediatric preventive cardiologists is an improved collaboration between primary care physicians, public health practitioners and policymakers, with the intent of systematically improving cardiovascular risk factor detection and response in childhood,” they wrote. “Having dedicated specialists trained in the management of severe pediatric lipid disorders and hypertension is of limited use if the patients are not identified and referred.”
The team also recommends that pediatric cardiologists integrate themselves into the community, which can help them reach more families and give them new opportunities to spread the word about making healthy lifestyle decisions.
The review article includes many more insights. Click here for the full analysis.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.