Pediatric Cardiovascular Risk Reduction Initiative

Since 1972, the National Heart, Lung and Blood Institute has coordinated the development of a series of clinical guidelines for the identification and management of risk factors for cardiovascular disease. For children, these have included most recently the 2004 Fourth Task Force Report on the Diagnosis, Evaluation and Treatment of High Blood Pressure in Children and Adolescents, and the National Cholesterol Education Program Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents. The development of atherosclerosis, which leads to clinical cardiovascular disease is mediated by the presence and intensity of well defined risk factors which include high blood pressure and elevated cholesterol levels. In many individuals, risk factors tend to cluster together and when this occurs, their impact on the development of atherosclerosis is accentuated. Many risk factors are present beginning in childhood and pathologic studies indicate that the presence and extent of atherosclerosis relates directly to the number and intensity of risk factors even in the first decade of life.

Since publication of the most recent guidelines, a great deal of new information has emerged, clarifying our knowledge about the combined impact of cardiovascular risk factors in childhood. Dr. Elizabeth Nabel, NHLBI Director, has convened an expert panel to develop a new integrated guideline, which will address all the known risk factors for development of atherosclerosis as part of routine pediatric care. Recommendations will be based on an evidence-based review of the literature. This guideline will be the first from NHLBI to address overall cardiovascular risk factor identification and risk reduction in children. The Expert Panel began work in the Fall 2006 and the guideline is scheduled for completion in the Fall 2008.