Fostering and Maintaining Cardiovascular Health in Children Key to a Healthier Population, Says AHA
New guidelines from the American Heart Association (AHA) are promoting preventative cardiovascular care in children in hopes of achieving the organization’s long-term goal of reducing all deaths from CV disease and stroke by 20% before 2020.
The statement, expanded from the AHA’s original guidelines on the topic from 2010, highlights the importance of certain health factors and behaviors—such as achieving ideal blood pressure and encouraging good dietary habits—during childhood. Also of note is the benefit these efforts, if begun early in life, might have on the total US population, according to the authors.
“Instead of taking a wait-and-see approach by treating disease later in adulthood, we should help children maintain the standards of ideal cardiovascular health that most children are born with,” Julia Steinberger, MD (University of Minnesota, Minneapolis), lead author of the new guidelines, said in a press release. “Engaging in these ideal health behaviors early in life can have a tremendous benefit on maintaining ideal health throughout the lifespan.”
The paper collects the existing data on CV risk factors and prevention to outline recommendations for physicians to use in clinical settings, but the overarching message spans beyond the exam rooms, co-author Donald Lloyd-Jones, MD (Northwestern Memorial Hospital, Chicago, IL), told TCTMD.
“This is really targeted at a broad audience to try to raise awareness of cardiovascular health and help us improve in measuring it [and] monitoring it, so that the long-term goal will be a much, much healthier population than we currently have,” said Lloyd-Jones, who was lead author of the first guidelines in 2010.
Ideal Heart Health in Children
Published online today in Circulation, the guidelines outline ideal outcomes for seven major factors in determining a child’s CV health. Chief among the factors is abstinence from tobacco use including electronic cigarettes. Other indicators are maintaining a body weight below the 85th percentile; getting more than 60 minutes of moderate-to-vigorous physical activity daily; and achieving various measures for healthy eating (Healthy Diet Score of 4-5 components), good levels of cholesterol (< 170 mg/dL), blood pressure (< 90th percentile), and blood glucose (< 100 mg/dL).
Overcoming the Challenges Together
The authors acknowledge the difficulty of monitoring factors like tobacco use and dietary habits, but stress the need for action, particularly when more than 90% of US children have poor diets. But the struggles physicians might face in monitoring a child’s CV health can be eased by a community effort beginning with the parents, according to Lloyd-Jones.
“I think this is an all-hands-on-deck kind of thing,” he said. “All of us need to be thinking about this, and doing what we can to improve our environment, our food supply, and [level of] physical activity, and really getting people focused on promoting health.”
The guidelines offer a fresh approach to achieving the AHA’s goals for 2020, said Michael Mendelson, MD (Boston Children’s Hospital, MA), pointing out that the effort marks the first time the group has turned to broad preventive care recommendations in children to improve CV outcomes in the overall population.
“It’s a shift in focus toward promoting ideal cardiovascular health before you lose these protective behaviors like physical activity and dietary factors, as opposed to identifying whose abnormal and treating abnormal [conditions],” he told TCTMD.
Mendelson, a pediatric preventative cardiologist, sees the AHA’s new statement as a positive step forward for the overall health goals because it collects all the current, relevant knowledge on this topic in children and highlights where further research is needed. While the paper does not directly outline how cardiologists treating adults can contribute, he suggested they also play a meaningful role.
Cardiologists of any specialty can help achieve these goals, and the key “is to remember the family and remember the children that accompany the adults that they see. They can be an agent for positive change in the family,” Mendelson said.
Michael H. Wilson is the 2016 recipient of the Jason Kahn Fellowship in Medical Journalism.
- Steinberger J, Daniels SR, Hagberg N, et al. Cardiovascular health promotion in children: challenges and opportunities for 2020 and beyond: a scientific statement from the American Heart Association. Circulation. 2016;Epub ahead of print.
- USPSTF: Not Enough Evidence to Recommend Routine Lipid Screening in Children and Adolescents
- TCT Keynote: Global Vision for Prevention in Children and Adults Could Change CVD Landscape
- Steinberger reports receiving grant funding from the National Institutes of Health/National Heart, Lung, and Blood Institute.
- Lloyd-Jones and Mendelson report having no relevant conflicts of interest.