Cardiovascular risk factors in children

Presented by
Dr Pankaj Yadav
drpankajyadav05@gmail.com
CARDIOVASCULAR RISK
FACTORS IN CHILDREN
1 drpankajyadav05@gmail.com

World Status of CVD
drpankajyadav05@gmail.com2
 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
 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

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.

 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.

 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

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.

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.

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.

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

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

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

Causes of obesity Other causes and
contributing factors:
 Environment
 Genetics
 Hormonal Disorders
 Culture
Medication
Induced
Weight-gain
Appetite/ cravings 13drpankajyadav05@gmail.com

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

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
 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

Total cholesterol by age and sex
Average distribution of plasma total cholesterol (means and selected percentiles)
Plasmatotalcholesterol(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

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
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 inhibitions20 drpankajyadav05@gmail.com

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

Hypertension
(As per 7th Joint National Committee on
Prevention, Detection, Evaluation, and Treatment of High Blood
Pressure )
22
 Systolic & diastolic BP>90th% 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.drpankajyadav05@gmail.com

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

 7-12 yr
 Renovascular abnormalities
 Endocrine causes
 Essential hypertension
 Adolescents
 Essential hypertension
 Endocrine causes

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

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

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
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

Cardiovascular risk factors in children

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