Atherosclerotic cardiovascular disease beginning in childhood

Abstract

Although the clinical manifestations of cardiovascular disease (CVD), such as myocardial infarction, stroke, and peripheral vascular disease, appear from middle age, the process of atherosclerosis can begin early in childhood. The early stage and progression of atherosclerosis in youth are influenced by risk factors that include obesity, hypertension, dyslipidemia, and smoking, and by the presence of specific diseases, such as diabetes mellitus and Kawasaki disease (KD). The existing evidence indicates that primary prevention of atherosclerotic disease should begin in childhood. Identification of children at risk for atherosclerosis may allow early intervention to decrease the atherosclerotic process, thereby preventing or delaying CVD. This review will describe the origin and progression of atherosclerosis in childhood, and the identification and management of known risk factors for atherosclerotic CVD in children and young adults.

Keywords: Adolescent; Atherosclerosis; Cardiovascular diseases; Child; Primary prevention.

Fig. 1

Natural history of atherosclerosis.

Fig. 2

Estimated probability of advanced atherosclerotic lesions in the coronary arteries by PDAY risk scores. PDAY: Pathobiological Determinants of Atherosclerosis in Youth.

Fig. 3

Risk-stratification and treatment algorithm for high-risk pediatric populations. Detailed informations on the treatment recommendations are available at Ref. Step 4-for tier I, initial management is therapeutic lifestyle change plus disease-specific management, while for tiers II and III, initial management is therapeutic lifestyle change; Step 5-for tiers II and III, if goals are not met after initial management, consider medication. FH: familial hypercholesterolemia, ESRD: end-stage renal disease, CV: cardiovascular, CAD: coronary artery disease, BP: blood pressure, LDL: low-density lipoprotein, FG: fasting glucose, HgbA_1c: hemoglobin A_1C, ht: height, pt: patient.