In 2002, the American Heart Association (AHA) published an updated version of its “Guide to Primary Prevention of Cardiovascular Disease.” It presented recommendations for the reduction of cardiovascular risk factors in adults. Since then, research has shown that the primary risk factors for cardiovascular disease (high cholesterol, high blood pressure, diabetes, lack of physical activity, overweight and obesity and smoking) are occurring in alarmingly increasing rates among children and young adults. These findings, in combination with evidence of the presence of fatty streaks (often the precursors to atherosclerotic lesions) in the arteries of children as young as three, led researchers to believe that the time to begin preventing cardiovascular disease is in childhood.

To address this need, the American Heart Association (AHA) published a new set of guidelines for the prevention of cardiovascular disease in children and young adults. The reason for establishing these new guidelines is two-fold. First, researchers have learned that behavior patterns adopted in childhood are carried into adulthood. Habits such as diet, level of physical activity and smoking have a large impact on the number of cardiovascular risk factors. Stopping them before they start is the best way to begin.

Second, consider the following statistics:

• Rates of obesity have doubled among US young people during the past two decades.
• In 2001, only 32% of high school students in the US attended some type of gym class every day.
• Approximately 10% of American adolescents between the ages of 12 and 19 have total cholesterol levels over 200 milligrams per deciliter (mg/dL[5.2 mmol/L]).
• According to a 2001 survey, 39% of male students and 30% of female students in grades 9-12 were actively using tobacco.
• Up to 25% of obese children and adolescents have impaired glucose tolerance, a problem that often leads to diabetes and heart disease in adults. Diabetes is one of the strongest known risk factors for heart disease. The overall prevalence of type 2 diabetes in children is much harder to estimate, but in some US minority populations it has risen as high as 5%.

Obviously, our children are at greater risk than ever of developing a disease that once only plagued their grandparents, and doing so at younger and younger ages.

About The Guidelines
The new guidelines represent a practical approach to the promotion of cardiovascular health in children. These guidelines are designed to be used by primary care physicians, specialists and parents alike.

The guidelines are broken down into two strategies. The first is a set of general recommendations directed at promoting cardiovascular health in all children and young adults. The second strategy is designed to help physicians and parents identify and manage those children who are at the highest risk for atherosclerotic disease. The following is a brief discussion of each strategy.

Guidelines for Cardiovascular Health in All Children and Adolescents
According to the AHA guidelines, there are a number of things you, as a parent, can do to promote cardiovascular health in your children:

• Encourage a healthful diet – emphasize eating fruits, vegetables, whole grains, dairy products, fish, legumes, poultry and lean meat.
• Encourage your child to maintain an appropriate body weight.
• Talk to your child about the importance of maintaining a desirable total cholesterol level through healthy eating.
• Talk to your child about the importance of maintaining a desirable blood pressure through healthy eating, weight awareness and daily exercise.
• After age two, limit consumption of high fat foods and trans fats (hydrogenated oils).
• Limit salt and sugar intake. Know about the DASH diet: high in vegetables, fruits, whole grains, and low-fat dairy products.
• Talk to your child about not smoking, and set a good example yourself.
• Actively work to limit your child’s exposure to tobacco smoke.
• If your child already smokes, help him/her quit.
• Encourage your child to be physically active every day.
• Limit the amount of time your child participates in sedentary activities (television, computers, video games, telephones).

Guidelines for Cardiovascular Risk Reduction in at Risk Children and Adolescents
If you and your child’s doctor determine that your child may be at risk for developing cardiovascular disease later in life, it will be important that the two of you work as a team to help your child reduce his or her risks. The AHA guidelines for reducing the risk of cardiovascular disease in these children include:

• Monitor your child’s cholesterol and other lipid levels
• Manage your child’s blood pressure. A child’s blood pressure will change as he or she ages, but try to keep this level below the 95th percentile for your child’s age, sex and height
• Manage your child’s weight by helping him or her achieve a BMI < 95th percentile for his or her age and sex.
• If your child is diabetic, work with him or her to manage the disease. This means teaching your child the importance of closely monitoring blood glucose levels.
• If your child doesn’t smoke, talk to him or her about the importance of not starting. If your child does smoke, work with him or her to kick the habit.

Above all, one of the most effective ways to teach your children about how to live a healthy lifestyle, is to follow one yourself. Children learn by example and the dietary and exercise patterns you demonstrate while they grow up will have a definite impact on the choices they make later in life.