New focus urged for kids' heart health

New guidelines say prevention of cardiovascular disease could begin in early childhood. But should it?

By Susan J. Landers, AMNews staff. April 14, 2003.

Washington -- Talk about early prevention -- the American Heart Assn. would like physicians to be alert for cardiovascular risk factors in their youngest patients, almost from the moment they first place a stethoscope on their tiny chests.

New guidelines developed by the heart association urge primary care physicians to consider family history of heart disease, diet and physical activity of their young patients and, if necessary, provide recommendations to families on changes that could forestall the future development of heart disease.

In some instances, drugs for hypertension and high cholesterol may be in order for children identified as being at high risk for early heart disease, according to the guidelines.

"There is now quite a large body of evidence documenting pathologic and physiologic changes when hypertension, high cholesterol and diabetes are present in childhood," said Rae-Ellen Kavey, MD, chair of cardiology at Children's Memorial Hospital in Chicago. Dr. Kavey is the lead author of the guidelines, which were published in the March 25 issue of Circulation.

The growing numbers of overweight children provide additional impetus for the guidelines. "The outbreak of obesity makes us feel we really can't afford not to be very actively and aggressively involved in counseling pediatricians, primary care physicians and families about how to be healthy," said Dr. Kavey.

"It's critical that primary care physicians screen and treat cardiovascular risk factors beginning as soon as they can," said Marc Jacobson, MD, director of the Center for Atherosclerosis Prevention at Schneider Children's Hospital in New York. "We know that atherosclerosis takes decades to develop, but we know that habits of good nutrition and physical activity also take a long time to develop and are very hard to change."