TABLE 11-3

Condition-Specific Treatment Recommendations for High-Risk Conditions

Rigorous age-appropriate education in diet, activity, smoking cessation for all
Specific therapy as needed to achieve BP, LDL cholesterol, glucose, and HbA1c goals indicated for each tier, as outlined in algorithm; timing individualized for each patient and diagnosis
DM regardless of type:
    For T1DM, intensive glucose management per endocrinologist with frequent glucose monitoring/insulin titration to maintain optimal plasma glucose and HbA1c levels for age
    For T2DM, intensive weight management and glucose control in consultation with an endocrinologist as needed to maintain optimal plasma glucose and HbA1c levels for age
    Assess BMI and fasting lipid levels: step 4 lifestyle management of weight and lipid levels for 6 mo
    If LDL goals are not achieved, consider statin therapy if age is ≥10 y to achieve tier 1 treatment goals for LDL cholesterol
    Initial BP ≥ 90th percentile: step 4 lifestyle management plus no added salt, increased activity for 6 mo
    If BP is consistently at the ≥95th percentile for age/gender/height, initiate angiotensin-converting enzyme inhibitor therapy with a BP goal of <90th percentile for gender/height or <120/80 mm Hg, whichever is lower
Chronic kidney disease/end-stage renal disease/post–renal transplant:
    Optimization of renal-failure management with dialysis/transplantation per nephrology
    Assess BMI, BP, and lipid and FG levels: step 4 lifestyle management for 6 mo
    If LDL goals are not achieved, consider statin therapy if age is ≥10 y to achieve tier 1 treatment goals for LDL cholesterol
    If BP is consistently at the ≥95th percentile for age/gender/height, initiate angiotensin-converting enzyme inhibitor therapy with a BP goal of <90th percentile for gender/height or <120/80 mm Hg, whichever is lower
After heart transplantation:
    Optimization of antirejection therapy, treatment for cytomegalovirus infection, routine evaluation by angiography/perfusion imaging per transplant physician
    Assess BMI, BP, and lipid and FG levels: initiate step 5 therapy, including statins, immediately for all patients aged ≥1 y to achieve tier 1 treatment goals
Kawasaki disease with current coronary aneurysms:
    Antithrombotic therapy, activity restriction, ongoing myocardial perfusion evaluation per cardiologist
    Assess BMI, BP, and lipid and FG levels: step 4 lifestyle management for 6 mo
    If goals are not achieved, consider pharmacologic therapy for LDL cholesterol and BP if age is ≥10 y to achieve tier 1 treatment goals
  • FG indicates fasting glucose.

  • Adapted from Kavey RE, Allada V, Daniels SR, et al; American Heart Association, Expert Panel on Population and Prevention Science; American Heart Association, Council on Cardiovascular Disease in the Young; American Heart Association, Council on Epidemiology and Prevention; American Heart Association, Council on Nutrition, Physical Activity and Metabolism; American Heart Association, Council on High Blood Pressure Research; American Heart Association, Council on Cardiovascular Nursing; American Heart Association, Council on the Kidney in Heart Disease; Interdisciplinary Working Group on Quality of Care and Outcomes Research. Circulation. 2006;114(24):2710–2738.