Cardiovascular risk factors in children


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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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Cardiovascular risk factors in children

  1. 1. Presented byDr Pankaj Yadavdrpankajyadav05@gmail.comCARDIOVASCULAR RISKFACTORS IN CHILDREN1
  2. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 12. OBESITYCauses of obesity: Consuming more calories than the bodyneeds.Usually from eating foods high infat/ calories.Lack of exercise12
  13. 13. Causes of obesity Other causes andcontributing factors: Environment Genetics Hormonal Disorders CultureMedicationInducedWeight-gainAppetite/ cravings
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  15. 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. 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. 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. 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. 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. 20. Causes of hyperlipidaemiaHYPERCHOLESTEROLEMIAHypothyrodismNephrotic syndromeCholestasisAnorexia nervosaDrugs:progesterone, thiazides, tegretol, cyclosporineHYPERTRIGLYCERIDEMIAObesityType II diabetesAlcoholRenal failureSepsisStressCushing syndromePregnancyHepatitisAIDS, protease inhibitions20
  21. 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. 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. 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. 24.  7-12 yr Renal parenchymal disease Renovascular abnormalities Endocrine causes Essential hypertension Adolescents Essential hypertension Renal parenchymal disease Endocrine causes24
  25. 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. 26. Diabetes contd. Limit sugar intake Maintain normal weight for age & height For type 1 diabetics, ongoing strict control (HgbA1c)26
  27. 27. Other Risk Factors27•Ethnicity (esp. SouthAsian/aboriginal/black/Hispanic)•Low socioeconomic level•Social isolation•Depression•Pregnancy (HTN and gestational diabetes)
  28. 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. 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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