Children with CV risk: new AHA guidance on risk reduction

  • de Ferranti SD & al.
  • Circulation
  • 25 Feb 2019

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • The American Heart Association (AHA) has released a scientific statement on risk reduction in children who have cardiovascular (CV) disease risk.
  • The publication includes an algorithm and a comprehensive listing of relevant guidelines.

Why this matters

  • Statement is for primary care clinicians, specialists, and subspecialists and focuses on management.

Key guidance

  • Children are grouped based on risk:
    • High risk includes history of diabetes, end-stage renal disease, stem cell therapy, transplant.
    • Moderate risk includes history of hypertension, severe obesity, familial hypercholesterolemia.
    • At risk includes history of insulin resistance, chronic inflammatory disease, cardiotoxic chemotherapy.
  • Algorithm starts with tiers based on risks; step 1 is to identify risk tier.
  • Step 2 is to consider all cardiovascular disease factors that are present; having 2+ elevates patient to next tier.
  • Step 3 is to use algorithm cut points (e.g., BMI, cholesterol, BP thresholds) to determine needed lifestyle changes (step 4) and/or drug therapies (step 5).
  • In general: 
    • High risk: management should be therapeutic lifestyle changes and management of the specific disease.
    • Moderate or at risk: therapeutic lifestyle change is first step, then consider medication.
  • Statement also offers a comprehensive table of resources for clinicians and patients, including guidelines for specific situations (e.g., severe obesity, chronic kidney disease).