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It is well known that atherosclerotic cardiovascular (heart) disease is the leading cause of death in adults and that it can be prevented with healthy habits. That is why there are so many guidelines about reducing heart disease risk factors in adults.

It is now also known that heart disease can begin in childhood, especially in overweight children, and there is a growing push to target prevention at younger children so that they don't develop heart disease as adults. Adults also often pick up their bad habits, including poor 'dietary habits, physical activity behaviors, and the use of tobacco' as kids.

The American Heart Association recently released a scientific statement, AHA Guidelines for Primary Prevention of Atherosclerotic Cardiovascular Disease Beginning in Childhood, that can help parents and health professionals identify and manage risk factors children can have that will increase their risk of having heart disease as an adult.

Although there is not a lot of new information in these guidelines, it puts all previous recommendations in one place, including health promotion goals and recommendations to meet them, guidelines to identify kids at risk for cardiovascular disease and how to reduce their risk.

Health Promotion Goals

The guideline's health promotion goals for diet, smoking and physical activity are likely to be the most useful for parents. These goals include having a healthy diet, appropriate body weight, not smoking, and being physcially active each day.

Among the specific recommendations to meet these goals include:

• eating a variety of fruits, vegetables, whole grains, dairy products, fish, legumes, poultry and lean meat
• limiting high fat foods once a child is two years old, including limiting foods high in saturated fats to less than 10% of calories each day, cholesterol to less than 300mg a day, and trans-fatty acids.
• limiting salt intake to less than 6g a day
• limiting the intake of sugar
• strongly advises kids to not begin smoking, stop smoking if they have already started, and avoiding second hand smoke.
• being physically active each day, with at least 60 minutes of moderate to vigorous fun physical activities each day, and limiting sedentary time watching TV, playing video games, talking on the phone, etc. to less than 2 hours a day.

Identifying High Risk Children

One of the best ways to identify kids at risk for cardiovascular disease is to look for risk factors in other family members, especially parents, grandparents, aunts and uncles. These risk factors include being overweight, having high blood pressure, high cholesterol, diabetes, or cardiovascular disease before age 55 for men or 65 for women. Having family members that smoke is another risk factor.

Children that have a family history of high cholesterol or early heart disease should have testing of fasting lipids after age 2. Those kids with other risk factors should have a lipid and lipoprotein analysis.

One of the other health promotion goals of this guideline is for children to have a 'desirable lipid profile', which would include having blood tests below the following values:

If the average results of three lipid profiles are above these cutoff values, interventions should be made to lower them.

Treatment of High Risk Children