Cardiovascular risk factors in children
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Cardiovascular risk factors in children



Represents 30% of all deaths worldwide (15 million deaths/year)

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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Cardiovascular risk factors in children Presentation Transcript

  • 1. Presented byDr Pankaj Yadavdrpankajyadav05@gmail.comCARDIOVASCULAR RISKFACTORS IN CHILDREN1
  • 2. World Status of CVDdrpankajyadav05@gmail.com2 Represents 30% of all deaths worldwide (15million deaths/year) Leading cause of death and disability CVD burden in developing countries Risk factors worldwide
  • 3. Non-modifiable risk factors Age Gender Family history of cardiovascular disease If a first-degree blood relative has had coronaryheart disease or stroke before the age of 55 years(for a male relative) or 65 years (for a femalerelative) risk increases. 1.7 times high risk in positive family history patient Ethnic origin - African or Asian ancestry are athigher risks of developing cardiovascular disease3
  • 4. 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 heartdisease and stroke.4
  • 5.  Tobacco whether it is smoking or chewingtobacco, increases risks of cardiovasculardisease Certain medicines may increase the risk of heartdisease such as the contraceptive pill andhormone replacement therapy (HRT). one to two alcohol drinks (50 ml – 80 ml) a daymay lead to a 30% reduction in heart disease, butabove this level alcohol consumption will damagethe heart muscle.5
  • 6.  Absence of key nutritional elements, such aspolyphenol antioxidants Higher fibrinogen and PAI-1 blood concentrations Elevated homocysteine. Elevated blood levels of asymmetricdimethylarginine High blood pressure Inadequate nutrition (neither over nor undernutrition)of pregnant women: Barker hypothesis6
  • 7. Heredity family history of coronary artery disease have 2times the risk of having a significant elevation incholesterol. The types of food, exercise habits, and exposureto smoking also run in families. Obesity can also be heriditary and contribute toincreased risk.7
  • 8. Gender Males have a higher incidence of heart disease atan earlier age. However, after the onset of menopause, theincidence of cardiovascular disease in womenmore closely approximates that of men. Generally, this means that women tend todevelop problems with heart disease 10 yearslater than men.8
  • 9. Obesity CDC Growth Charts are used to determine thecorresponding BMI-for-age and sex percentile. Forchildren and adolescents (aged 2—19 years) Overweight is defined as a BMI at or above the 85thpercentile and lower than the 95th percentile forchildren of the same age and sex. Obesity is defined as a BMI at or above the 95thpercentile for children of the same age and sex.9
  • 10. Body Mass Index (BMI)Classification of Children andAdolescents<5th percentile Underweight5th–84th percentile Normal weight85th–94th percentile At risk for overweight≥95th percentile Overweight10
  • 11. Body Mass Index (BMI)Classification of Adults<18.5 Underweight18.5–24.9 Normal weight25–29.9 Overweight30–34.9 Obese35–39.9 Moderately obese40–49.9 Morbid obesity≥50 Super morbid obesity11
  • 12. OBESITYCauses of obesity: Consuming more calories than the bodyneeds.Usually from eating foods high infat/ calories.Lack of exercise12
  • 13. Causes of obesity Other causes andcontributing factors: Environment Genetics Hormonal Disorders CultureMedicationInducedWeight-gainAppetite/ cravings
  • 14. 14
  • 15. Physical Inactivity Adults ages 18-65 should be getting at least 30 minutesof moderate intensity activity five days of the week. At least 60% of the global population fails to achieve theminimum recommendationRisk Factors for : Coronary Heart Disease High blood cholesterol High Blood Pressure Obesity and Diabetes Cardiovascular Disease Stroke15
  • 16. Physical Inactivity16 Physical activity every day (60 minutes per dayfor children) Reduce/limit sedentary time (e.g.. TV maximum 2hours per day) May add resistance training to aerobic activity
  • 17. Raised cholesterol levels The pathogenesis of atherosclerosis begins duringchildhood Korean and Vietnam war casualties were noted tohave surprisingly advanced fatty streak and plaqueformation in the coronary arteries and aorta The Johns Hopkins Precursors Study demonstratedthat white male medical students with bloodcholesterol levels in the lowest quartile showed onlya 10% incidence of CHD three decades later,whereas those in the highest quartile had a 40%incidence17
  • 18. Total cholesterol by age and sexAverage distribution of plasma total cholesterol (means and selected percentiles)Plasmatotalcholesterol(mg/dL)Age (years) Age (years)3202802402001601200 10 20 30 40 50 60 70 0 10 20 30 40 50 60 70White males White females90thMean50th10th90thMean50th10th18
  • 19. Lipids & Lipoproteins19 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
  • 20. Causes of hyperlipidaemiaHYPERCHOLESTEROLEMIAHypothyrodismNephrotic syndromeCholestasisAnorexia nervosaDrugs:progesterone, thiazides, tegretol, cyclosporineHYPERTRIGLYCERIDEMIAObesityType II diabetesAlcoholRenal failureSepsisStressCushing syndromePregnancyHepatitisAIDS, protease inhibitions20
  • 21. Familial hypercholesterolemia(Type II hyperlipoproteinemia) genetic disorder caused by a defect onchromosome 19 autosomal dominant defect makes the body unable to remove lowdensity lipoprotein (LDL, or "bad") cholesterolfrom the blood High levels of LDL cholesterol make you morelikely to have narrowing of the arteries fromatherosclerosis at an early age21
  • 22. Hypertension(As per 7th Joint National Committee onPrevention, Detection, Evaluation, and Treatment of High BloodPressure )22 Systolic & diastolic BP>90th% for age, sex and heightis abnormal. Stage I hypertension• is diagnosed if a child’s BP is greater than the95th percentile but less than or equal to the 99thpercentile plus 5 mm Hg. Stage II hypertension• is diagnosed if a child’s BP is greater than the 99thpercentile plus 5 mm
  • 23. 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 aorta23
  • 24.  7-12 yr Renal parenchymal disease Renovascular abnormalities Endocrine causes Essential hypertension Adolescents Essential hypertension Renal parenchymal disease Endocrine causes24
  • 25. Diabetes25 patients with type 1 diabetes or type 2 diabetes areat high risk for several cardiovascular disorders:coronary heart disease, stroke, peripheral arterialdisease, cardiomyopathy, and congestive heartfailure. Cardiovascular complications are now the leadingcauses of diabetes-related morbidity and mortality Prospective studies, such as theFramingham, Honolulu, and San Antonio HeartStudies had mentioned it as an independent riskfactor for coronary heart
  • 26. Diabetes contd. Limit sugar intake Maintain normal weight for age & height For type 1 diabetics, ongoing strict control (HgbA1c)26
  • 27. Other Risk Factors27•Ethnicity (esp. SouthAsian/aboriginal/black/Hispanic)•Low socioeconomic level•Social isolation•Depression•Pregnancy (HTN and gestational diabetes)
  • 28. Childhood Abuse28 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 4xDong M et al CIRC 110;
  • 29. Tobacco SmokeFacts: 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 yearRisk 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 cancer29
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