Cardiovascular risk factors in children

Category: Education

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Represents 30% of all deaths worldwide (15 million deaths/year) Leading cause of death and disability CVD burden  in developing countries Risk factors  worldwide


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World Status of CVD:

World Status of CVD 2 Represents 30% of all deaths worldwide (15 million deaths/year) Leading cause of death and disability CVD burden  in developing countries Risk factors  worldwide

Non-modifiable risk factors:

Non-modifiable risk factors Age Gender Family history of cardiovascular disease If a first-degree blood relative has had coronary heart disease or stroke before the age of 55 years (for a male relative) or 65 years (for a female relative) risk increases. 1.7 times high risk in positive family history patient Ethnic origin - African or Asian ancestry are at higher risks of developing cardiovascular disease 3

Modifiable risk factors:

Modifiable risk factors Hypertension Abnormal blood lipid levels Physical inactivity Type 2 diabetes A diet high in saturated fat Being poor, no matter where in the globe, increases risk of heart disease and stroke. A chronically stressful life, social isolation, anxiety and depression increase the risk of heart disease and stroke. 4

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Tobacco  whether it is smoking or chewing tobacco, increases risks of cardiovascular disease Certain medicines may increase the risk of heart disease such as the contraceptive pill and hormone replacement therapy (HRT). one to two alcohol drinks (50 ml – 80 ml) a day may lead to a 30% reduction in heart disease, but above this level alcohol consumption will damage the heart muscle. 5

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Absence of key nutritional elements, such as polyphenol antioxidants Higher fibrinogen and PAI-1 blood concentrations Elevated homocysteine . Elevated blood levels of asymmetric dimethylarginine High blood pressure Inadequate nutrition (neither over nor undernutrition ) of pregnant women: Barker hypothesis 6

Heredity :

Heredity family history of coronary artery disease have 2 times the risk of having a significant elevation in cholesterol. The types of food, exercise habits, and exposure to smoking also run in families. Obesity can also be heriditary and contribute to increased risk. 7

Gender :

Gender Males have a higher incidence of heart disease at an earlier age. However, after the onset of menopause, the incidence of cardiovascular disease in women more closely approximates that of men. Generally, this means that women tend to develop problems with heart disease 10 years later than men. 8

Obesity :

Obesity CDC Growth Charts are used to determine the corresponding BMI-for-age and sex percentile. For children and adolescents (aged 2—19 years) Overweight is defined as a BMI at or above the 85th percentile and lower than the 95th percentile for children of the same age and sex. Obesity is defined as a BMI at or above the 95th percentile for children of the same age and sex. 9

Body Mass Index (BMI) Classification of Children and Adolescents:

Body Mass Index (BMI) Classification of Children and Adolescents <5th percentile Underweight 5th–84th percentile Normal weight 85th–94th percentile At risk for overweight ≥95th percentile Overweight 10

Body Mass Index (BMI) Classification of Adults:

Body Mass Index (BMI) Classification of Adults <18.5 Underweight 18.5–24.9 Normal weight 25–29.9 Overweight 30–34.9 Obese 35–39.9 Moderately obese 40–49.9 Morbid obesity ≥50 Super morbid obesity 11


OBESITY Causes of obesity: Consuming more calories than the body needs. Usually from eating foods high in fat/ calories. Lack of exercise 12

Causes of obesity :

Causes of obesity Other causes and contributing factors: Environment Genetics Hormonal Disorders Culture Medication Induced Weight-gain Appetite/ cravings 13

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Physical Inactivity:

Physical Inactivity Adults ages 18-65 should be getting at least 30 minutes of moderate intensity activity five days of the week. At least 60% of the global population fails to achieve the minimum recommendation Risk Factors for : Coronary Heart Disease High blood cholesterol High Blood Pressure Obesity and Diabetes Cardiovascular Disease Stroke 15

Physical Inactivity :

Physical Inactivity 16 Physical activity every day (60 minutes per day for children) Reduce/limit sedentary time (e.g.. TV maximum 2 hours per day) May add resistance training to aerobic activity in adolescents

Raised cholesterol levels:

Raised cholesterol levels The pathogenesis of atherosclerosis begins during childhood Korean and Vietnam war casualties were noted to have surprisingly advanced fatty streak and plaque formation in the coronary arteries and aorta The Johns Hopkins Precursors Study demonstrated that white male medical students with blood cholesterol levels in the lowest quartile showed only a 10% incidence of CHD three decades later, whereas those in the highest quartile had a 40% incidence 17

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Total cholesterol by age and sex Average distribution of plasma total cholesterol (means and selected percentiles) Plasma total cholesterol (mg/dL) Age (years) Age (years) 320 280 240 200 160 120 0 10 20 30 40 50 60 70 0 10 20 30 40 50 60 70 White males White females 90th Mean 50th 10th 90th Mean 50th 10th 18

Lipids & Lipoproteins:

Lipids & Lipoproteins 19 Total cholesterol <4.4 mmol /L recommended (USA>170mg/ dL borderline; >200 mg/ dL is  ) LDL-C <2.85 mmol /L recommended (USA<110mg/ dL ) Triglycerides <1.5 mmol /L recommended (USA <150 mg/ dL ) HDL-C >35 mg/ dL recommended

Causes of hyperlipidaemia:

Causes of hyperlipidaemia HYPERCHOLESTEROLEMIA Hypothyrodism Nephrotic syndrome Cholestasis Anorexia nervosa Drugs:progesterone , thiazides , tegretol , cyclosporine HYPERTRIGLYCERIDEMIA Obesity Type II diabetes Alcohol Renal failure Sepsis Stress Cushing syndrome Pregnancy Hepatitis AIDS, protease inhibitions 20

Familial hypercholesterolemia (Type II hyperlipoproteinemia):

Familial hypercholesterolemia (Type II hyperlipoproteinemia ) genetic disorder caused by a defect on chromosome 19 autosomal dominant defect makes the body unable to remove low density lipoprotein (LDL, or "bad") cholesterol from the blood High levels of LDL cholesterol make you more likely to have narrowing of the arteries from atherosclerosis at an early age 21

Hypertension (As per 7th Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure ):

Hypertension ( As per 7 th Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure ) 22 Systolic & diastolic BP>90 th % for age, sex and height is abnormal. Stage I hypertension is diagnosed if a child’s BP is greater than the 95th percentile but less than or equal to the 99th percentile plus 5 mm Hg. Stage II hypertension is diagnosed if a child’s BP is greater than the 99th percentile plus 5 mm Hg. >130/~80 is almost always pathological in youth.

Causes of hypertension:

Causes of hypertension Infants Thrombosis of renal artery or vein Congenital renal anomalies Coarctation of aorta Bronchopulmonary dysplasia 1-6 yr Renal artery stenosis Renal parenchymal disease Wilms tumor Neuroblastoma Coarctation of aorta 23

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7-12 yr Renal parenchymal disease Renovascular abnormalities Endocrine causes Essential hypertension Adolescents Essential hypertension Renal parenchymal disease Endocrine causes 24


Diabetes 25 patients with type 1 diabetes or type 2 diabetes are at high risk for several cardiovascular disorders: coronary heart disease, stroke, peripheral arterial disease, cardiomyopathy , and congestive heart failure. Cardiovascular complications are now the leading causes of diabetes-related morbidity and mortality Prospective studies, such as the Framingham, Honolulu, and San Antonio Heart Studies had mentioned it as an independent risk factor for coronary heart disease.

Diabetes contd.:

Diabetes contd. Limit sugar intake Maintain normal weight for age & height For type 1 diabetics, ongoing strict control ( Hgb A1c) 26

Other Risk Factors:

Other Risk Factors 27 Ethnicity ( esp. South Asian/aboriginal/black/Hispanic) Low socioeconomic level Social isolation Depression Pregnancy (HTN and gestational diabetes )

Childhood Abuse:

Childhood Abuse 28 Adverse childhood experiences (ACEs) 1.7x  risk with emotional abuse 1.7x  risk with crime in household 1.3x  risk with emotional neglect 1.3x  risk with substance abuse Depressed  2.1 Anger:  2.5 7 or > ACEs  risk almost 4x Dong M et al CIRC 110; 2004

Tobacco Smoke:

Tobacco Smoke Facts : In the United States, an estimated 25.9 million men (23.9 percent) and 20.7 million women (18.1 percent) are smokers Smokers' risk of heart disease is 2–4 times that of nonsmokers. Smoking accounts for nearly 440,000 deaths each year Risk Factors : High blood cholesterol High blood pressure Physical inactivity Obesity and Diabetes Stroke Damage the Cerebrovascular System Fatty buildups in arteries which causes cancer and lung cancer 29

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Thank you 30

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