Do You Know When to Screen for Cardiovascular Risk Factors?

It is well known that the number of children developing risk factors for atherosclerosis, including obesity, dyslipidemia and type 2 diabetes, has grown markedly over the past few decades.

As trusted frontline practitioners, pediatricians and primary care physicians are in an ideal position to watch for early warning signs and intervene to inhibit progression towards clinical disease.

“It is important for PCPs to be aware of these issues, and to screen and counsel patients appropriately,” says Cleveland Clinic pediatric endocrinologist Roy Kim, MD. “They need to make sure there are no complications and educate parents on the benefits of starting early with healthy eating and an active lifestyle.”

Identification and management of risk factors

Beyond “common sense” lifestyle suggestions, the issue of when to begin screening for cardiovascular risk factors looms large. A document issued by the National Heart, Lung and Blood Institute can be helpful in this regard.

The Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents is a comprehensive guideline that serves two purposes: risk factor prevention, and the prevention of cardiovascular disease by effective management of identified risk factors.

The Panel advises that blood pressure checks begin at age 3 (page 27) and lipid screenings between ages 9 and 11 (page 42).

Because type 2 diabetes is rare in early childhood, a fasting plasma glucose and hemoglobin A1c is recommended for children ages 10 and older who are overweight and have additional risk factors based on race, ethnicity, family history of type 2 diabetes and darkening of neck skin, a sign of insulin resistance (page 67).

Detailed testing recommendations for children with risk factors are condensed in a convenient table found on page 8.

PCs hold the key

Although the increase in obesity rates has slowed in very young children, Cleveland Clinic pediatricians and pediatric specialists continue to see an alarming number of overweight children with type 2 diabetes and pre-diabetes. That’s what prompted Dr. Kim to remind frontline practitioners that they hold the key to their patients’ future health.

“It’s important to revisit the issue periodically and make sure we stay up-to-date with recommendations,” he says.