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Pediatric Prevention

Pediatric prevention 

  • Increasing number of risk factors are highly correlated with acceleration and severity of atherosclerosis in various arteries.1, 2 Prevention and intervention need to target multiple risk factors and begin in early life. The best offense against heart disease is aggressive prevention, not expensive treatment.
  • The best form of prevention is primordial ─ before risk factors evolve and damage the heart and blood vessels.3  More importantly, primordial prevention of cardiovascular disease (CVD) should begin earlier in the life course, because the atherosclerotic process develops silently for decades before clinical events such as heart attack or stroke occur.4
  • Epidemiological studies have shown that it may be possible to modify cardiovascular disease risk by favorable lifestyle changes (e.g., healthy  diet, adequate physical activity, smoking restriction).5
  • The Cardiovascular Risk in Young Finns Study is an ongoing 5-center follow-up study of atherosclerosis risk  factors in Finnish children and adolescents. Participants were followed up since 1980 and had lifestyle risk factor data since childhood (3 to 18 years). Arterial pulse wave velocity was determined in young adulthood (aged 30 to 45 years) because it is a marker of arterial stiffness and an independent predictor of CVD  events and all-cause mortality.6
  •  The researchers showed that high fruit and vegetable consumption was associated with lower pulse wave velocity─ an indicator of arterial stiffness and future risk of CVD. The decrease in pulse wave velocity was more evident if the consumption of fruits and vegetables remained high from childhood to adulthood. It is also important to modify all lifestyle risk factors (low fruit consumption, low vegetable consumption, low physical activity, and smoking) in childhood because multiple risk factors led to increased  arterial stiffness in this study. These findings highlight the importance of emphasizing lifestyle as early as in childhood in the primary prevention of cardiovascular disease. 6
  • Efforts are underway for Fast food restaurants to provide healthier meals for children in the US. More than 15,000 restaurants across the country agreed to offer healthier children’s meals as part of a voluntary measure known as Kids Live Well. The 600 calorie meals will include two servings of fruits, vegetables, whole grains, lean protein, and low-fat dairy. The meals will also follow federal regulations for salt, fat, and sugar, and will offer a side dish of less than 200 calories.
  • Nineteen restaurant chains, including Burger King, IHOP, and Friendly’s are participating in the initiative started by the National Restaurant Association. More meal options and restaurants are expected to join the measure in the near future. 
  • Worldwide, prevention efforts are limited because it does not generate revenue or respect. 

Sources

1. Berenson GS, Wattigney WA, Tracy RE, et al. Atherosclerosis of the aorta and coronary arteries and cardiovascular risk factors in persons aged 6 to 30 years and studied at necropsy (The Bogalusa Heart Study). Am J Cardiol. Oct 1 1992;70(9):851-858.

2. Berenson GS, Srinivasan SR, Bao W, Newman WP, 3rd, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med. 1998;338(23):1650-1656.

3. Rose G. The strategy of preventive medicine. New York: Oxford University Press; 1992.

4.  Kavey RE, Allada V, Daniels SR, et al. Cardiovascular risk reduction in high-risk pediatric patients: a scientific statement from the American Heart Association Expert Panel on Population and Prevention Science; the Councils on Cardiovascular Disease in the Young, Epidemiology and Prevention, Nutrition, Physical Activity and Metabolism, High Blood Pressure Research, Cardiovascular Nursing, and the Kidney in Heart Disease; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation. Dec 12 2006;114(24):2710-2738.

5. Gidding SS. Assembling evidence to justify prevention of atherosclerosis beginning in youth. Circulation. Dec 14 2010;122(24):2493-2494.

6. Aatola H, Koivistoinen T, Hutri-Kahonen N, et al. Lifetime Fruit and Vegetable Consumption and Arterial Pulse Wave Velocity in Adulthood: The Cardiovascular Risk in Young Finns Study. Circulation. Nov 29 2010.

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