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Cardiovascular Perspectives

Prevention of Future Cardiovascular Disease in High-Risk Pediatric Patients

A Role for Lipid Lowering Therapy?

Sara K. Pasquali, MD and Jennifer S. Li, MD, MHS

From the Division of Cardiology, Department of Pediatrics, Duke University Medical Center and Duke Clinical Research Institute, Durham, NC.

Correspondence to Sara K. Pasquali, MD, Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715. E-mail sara.pasquali@duke.edu

Key Words: cardiovascular diseases • pediatrics • pharmacology

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Over the past 3 decades, childhood obesity has increased dramatically and has been deemed an epidemic by the Centers for Disease Control and Prevention.¹ The 2002 National Health and Nutrition Examination Survey reported that the prevalence of overweight and obese children aged 6 to 19 years was 31%, a 45% increase from the previous survey.² Obesity has been linked to comorbid conditions in children, including type 2 diabetes mellitus, hypertension, and hyperlipidemia.^3,4 There is widespread concern that the increasing prevalence of these cardiovascular risk factors in the pediatric population will lead to a dramatic rise in adult cardiovascular disease. However, because of the difficulty associated with conducting long-term longitudinal studies necessary to validate these concerns, most investigations in this area, to date, have focused on the relationship between childhood obesity and surrogate markers of cardiovascular disease. The presence of obesity, hyperlipidemia, and hypertension in childhood has been linked to elevated left ventricular mass and carotid intima-media thickness, as well as peripheral endothelial dysfunction.^4–7 These have been shown to be markers of cardiovascular risk in adult patients.^8–10 Other studies have shown that childhood obesity and associated comorbidities are related to early atherosclerosis. In an autopsy series, Berenson et al¹¹ showed that the presence and severity of coronary atherosclerotic plaque in asymptomatic young adults was significantly related to the number of risk factors present, including higher body mass index, hypertension, and hyperlipidemia. A recent Danish study is the first to demonstrate a link between childhood obesity and cardiovascular events in adulthood. Baker . . . [Full Text of this Article]