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. Presented by
Dr Pankaj Yadav
drpankajyadav05@gmail.com
CARDIOVASCULAR RISK
FACTORS IN CHILDREN
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2. World Status of CVD
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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
3. Non-modifiable risk factors
Age
Gender
Family history of cardiovascular disease
If a first-degree blood relative has had coronary
heart disease or stroke before the age of 55 years
(for a male relative) or 65 years (for a female
relative) risk increases.
1.7 times high risk in positive family history patient
Ethnic origin - African or Asian ancestry are at
higher risks of developing cardiovascular disease
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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 heart
disease and stroke.
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5. Tobacco whether it is smoking or chewing
tobacco, increases risks of cardiovascular
disease
Certain medicines may increase the risk of heart
disease such as the contraceptive pill and
hormone replacement therapy (HRT).
one to two alcohol drinks (50 ml – 80 ml) a day
may lead to a 30% reduction in heart disease, but
above this level alcohol consumption will damage
the heart muscle.
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6. Absence of key nutritional elements, such as
polyphenol antioxidants
Higher fibrinogen and PAI-1 blood concentrations
Elevated homocysteine.
Elevated blood levels of asymmetric
dimethylarginine
High blood pressure
Inadequate nutrition (neither over nor undernutrition)
of pregnant women: Barker hypothesis
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7. Heredity
family history of coronary artery disease have 2
times the risk of having a significant elevation in
cholesterol.
The types of food, exercise habits, and exposure
to smoking also run in families.
Obesity can also be heriditary and contribute to
increased risk.
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8. Gender
Males have a higher incidence of heart disease at
an earlier age.
However, after the onset of menopause, the
incidence of cardiovascular disease in women
more closely approximates that of men.
Generally, this means that women tend to
develop problems with heart disease 10 years
later than men.
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9. Obesity
CDC Growth Charts are used to determine the
corresponding BMI-for-age and sex percentile. For
children and adolescents (aged 2—19 years)
Overweight is defined as a BMI at or above the 85th
percentile and lower than the 95th percentile for
children of the same age and sex.
Obesity is defined as a BMI at or above the 95th
percentile for children of the same age and sex.
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10. Body Mass Index (BMI)
Classification of Children and
Adolescents
<5th percentile Underweight
5th–84th percentile Normal weight
85th–94th percentile At risk for overweight
≥95th percentile Overweight
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11. Body Mass Index (BMI)
Classification of Adults
<18.5 Underweight
18.5–24.9 Normal weight
25–29.9 Overweight
30–34.9 Obese
35–39.9 Moderately obese
40–49.9 Morbid obesity
≥50 Super morbid obesity
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12. OBESITY
Causes of obesity:
Consuming more calories than the body
needs.
Usually from eating foods high in
fat/ calories.
Lack of exercise
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13. Causes of obesity Other causes and
contributing factors:
Environment
Genetics
Hormonal Disorders
Culture
Medication
Induced
Weight-gain
Appetite/ cravings 13drpankajyadav05@gmail.com
15. Physical Inactivity
Adults ages 18-65 should be getting at least 30 minutes
of moderate intensity activity five days of the week.
At least 60% of the global population fails to achieve the
minimum recommendation
Risk Factors for :
Coronary Heart Disease
High blood cholesterol
High Blood Pressure
Obesity and Diabetes
Cardiovascular Disease
Stroke
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16. Physical Inactivity
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Physical activity every day (60 minutes per day
for children)
Reduce/limit sedentary time (e.g.. TV maximum 2
hours per day)
May add resistance training to aerobic activity in
adolescents
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17. Raised cholesterol levels
The pathogenesis of atherosclerosis begins during
childhood
Korean and Vietnam war casualties were noted to
have surprisingly advanced fatty streak and plaque
formation in the coronary arteries and aorta
The Johns Hopkins Precursors Study demonstrated
that white male medical students with blood
cholesterol levels in the lowest quartile showed only
a 10% incidence of CHD three decades later,
whereas those in the highest quartile had a 40%
incidence
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18. Total cholesterol by age and sex
Average distribution of plasma total cholesterol (means and selected percentiles)
Plasmatotalcholesterol(mg/dL)
Age (years) Age (years)
320
280
240
200
160
120
0 10 20 30 40 50 60 70 0 10 20 30 40 50 60 70
White males White females
90th
Mean
50th
10th
90th
Mean
50th
10th
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21. Familial hypercholesterolemia
(Type II hyperlipoproteinemia)
genetic disorder caused by a defect on
chromosome 19
autosomal dominant
defect makes the body unable to remove low
density lipoprotein (LDL, or "bad") cholesterol
from the blood
High levels of LDL cholesterol make you more
likely to have narrowing of the arteries from
atherosclerosis at an early age
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22. Hypertension
(As per 7th Joint National Committee on
Prevention, Detection, Evaluation, and Treatment of High Blood
Pressure )
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Systolic & diastolic BP>90th% for age, sex and height
is abnormal.
Stage I hypertension
• is diagnosed if a child’s BP is greater than the
95th percentile but less than or equal to the 99th
percentile plus 5 mm Hg.
Stage II hypertension
• is diagnosed if a child’s BP is greater than the 99th
percentile plus 5 mm Hg.drpankajyadav05@gmail.com
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 aorta
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25. Diabetes
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patients with type 1 diabetes or type 2 diabetes are
at high risk for several cardiovascular disorders:
coronary heart disease, stroke, peripheral arterial
disease, cardiomyopathy, and congestive heart
failure.
Cardiovascular complications are now the leading
causes of diabetes-related morbidity and mortality
Prospective studies, such as the
Framingham, Honolulu, and San Antonio Heart
Studies had mentioned it as an independent risk
factor for coronary heart disease.
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26. Diabetes contd.
Limit sugar intake
Maintain normal weight for age & height
For type 1 diabetics, ongoing strict control (Hgb
A1c)
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27. Other Risk Factors
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•Ethnicity (esp. South
Asian/aboriginal/black/Hispanic)
•Low socioeconomic level
•Social isolation
•Depression
•Pregnancy (HTN and gestational diabetes)
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28. Childhood Abuse
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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 4x
Dong M et al CIRC 110; 2004
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29. Tobacco Smoke
Facts:
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 year
Risk 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 cancer
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