Atherosclerotic cardiovascular disease (CVD) remains the leading cause of death in North Americans, but manifest disease in childhood and adolescence is rare. By contrast, risk factors and risk behaviors that accelerate the development of atherosclerosis begin in childhood, and there is increasing evidence that risk reduction delays progression toward clinical disease. In response, the former director of the National Heart, Lung, and Blood Institute (NHLBI), Dr Elizabeth Nabel, initiated development of cardiovascular health guidelines for pediatric care providers based on a formal evidence review of the science with an integrated format addressing all the major cardiovascular risk factors simultaneously. An expert panel was appointed to develop the guidelines in the fall of 2006.
The goal of the expert panel was to develop comprehensive evidence-based guidelines that address the known risk factors for CVD (Table 1-1) to assist all primary pediatric care providers in both the promotion of cardiovascular health and the identification and management of specific risk factors from infancy into young adult life. An innovative approach was needed, because a focus on cardiovascular risk reduction in children and adolescents addresses a disease process (atherosclerosis) in which the clinical end point of manifest CVD is remote. The recommendations, therefore, need to address 2 different goals: the prevention of risk-factor development (primordial prevention) and the prevention of future CVD by effective management of identified risk factors (primary prevention).
The evidence review also required an innovative approach. Most systematic evidence reviews include 1 or, at most, a small number of finite questions that address the impact of specific interventions on specific health outcomes, and a rigorous literature review often results in only a handful of in-scope articles for inclusion. Typically, evidence is limited to randomized controlled trials (RCTs), systematic reviews, and meta-analyses published over a defined time period. There …
Address correspondence to Janet M. de Jesus, MS, RD, 31 Center Dr, Building 31, Room 4A17, MSC 2480, Bethesda, MD 20892. E-mail: