"Many studies have shown an association between atherosclerosis and high cholesterol, high blood pressure and obesity beginning in children as young as 5 years old," says Dr. Rae-Ellen Kavy, chairman of cardiology at the Children's Memorial Hospital in Chicago and lead author of the guidelines.
Yet, she adds, while guidelines exist for preventive care for adults at risk for heart disease, there were no similar guidelines for children despite the knowledge that early intervention can be enormously effective in delaying the onset of disease.
"It's a process that begins in childhood, so guidelines have to begin in childhood," she says.
Kavey presented the guidelines March 6 at the American Heart Association's annual conference on cardiovascular disease epidemiology and prevention in Miami.
A year in the making, the guidelines present a comprehensive list of the health risks associated with heart disease, including overweight, high blood pressure and/or cholesterol, diabetes and a family history of heart disease. They are followed by recommendations to pediatricians for reducing those risks.
"It's all put together in one statement to emphasize that physicians need to think of these things together. It's something to put on a bulletin board in their offices," says Dr. Stephen Daniels, a pediatrics professor at Cincinnati Children's Hospital Medical Center who also worked on the guidelines.
The guidelines offer a list of things doctors can do to promote cardiovascular health in all children and directives for young people already at risk for heart disease. Included as well is a large bibliography of studies for doctors who want to read the research upon which the recommendations are based.
For otherwise healthy children and teens, suggestions are to regularly assess children's heart health by checking weight, blood pressure and lipid levels if deemed necessary. The guidelines also ask doctors to recommend healthy food choices, such as eating more fruits and vegetables, to restrict the intake of saturated fats to less than 10 percent of a child's daily caloric intake and to keep sugar intake low.
Next, the guidelines emphasize the importance of limiting sedentary activity -- no more than two hours of television and/or sitting at the computer, for instance -- and being physically active every day. The dangers of smoking are also discussed.
The authors hope this focus will prompt healthier behaviors when children are young.
"It's much easier to establish healthy eating and physical activity patterns than to change unhealthy patterns later," Kavey says.
The second part of the guidelines targets those children or teenagers already at high risk of cardiovascular disease. These include children with a Body Mass Index (BMI) over the 85th percentile for age, height and weight, a blood pressure reading in the 90th percentile for age, sex and height and a cholesterol reading of 170 or higher. Also putting children at higher risk is family history of heart disease, particularly if male family relatives had heart disease before age 55 and female relatives before the age of 65.
Information here concerns specific monitoring of weight, diet and physical activity, blood pressure, cholesterol and recommendations for interventions with medications.
"These guidelines are excellent tools for educating pediatric providers," says Dr. Thomas Klitzner, chief of pediatric cardiology at the Mattel Children's Hospital, University of California at Los Angeles.
"The problems, particularly of obesity, are daunting, and steps like this are essential if we are going to begin to approach a solution to this problem," he adds.
For a comprehensive look at obesity, you can visit The National Institute of Diabetes and Digestive and Kidney Diseases. More information on children and heart disease can be found at The American Heart Association.