Background
In 2005, based on recommendations from experts convened in a national Thought Leaders
Meeting, the National Heart, Lung, and Blood Institute (NHLBI), under the leadership
of the Director Elizabeth G. Nabel, M.D., endorsed a new approach for guideline
development. This new approach is characterized by a formal evidence review and
an integrated format with the major cardiovascular (CV) risk factors addressed simultaneously
in a single guideline document.
Atherosclerotic cardiovascular disease (CVD) remains the leading cause of death
among North Americans. Although manifest disease in childhood and adolescence is
rare, 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. To address this health issue, the NHLBI appointed
an Expert Panel to develop cardiovascular (CV) health and risk reduction guidelines
for pediatric care providers based on the new approach, using a formal evidence
review of this science with an integrated format addressing all the major CV risk
factors simultaneously. This publication, Full Report of the Expert Panel on Integrated
Guidelines for Pediatric Cardiovascular Health and Risk Reduction, is the
result of the Expert Panel's work
Chaired by Dr. Stephen R. Daniels, the Expert Panel's goal was development of evidence-based
guidelines addressing all of the major risk factors to assist pediatric care providerspediatricians,
family practitioners, nurses and nurse practitioners, physician assistants, and
registered dietitiansin both the promotion of CV health and the identification
and management of specific risk factors from infancy to young adulthood. The Expert
Panel determined that a focus on CV risk reduction in children and adolescents addresses
a disease processatherosclerosisin which the clinical endpoint of manifest
CVD is much later in life. Therefore, the recommendations would need to address
both the prevention of risk factor developmentprimordial preventionand
the prevention of future CVD by effective management of identified risk factorsprimary
prevention.
There have been no previous NHLBI-appointed expert panels that addressed multiple
risk factors in children. Previous CV pediatric guidelines have addressed cholesterol
(National Cholesterol Education Program: Report of the Expert Panel on Blood
Cholesterol Levels in Children and Adolescents (1992)) and blood pressure
(The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure
in Children and Adolescents (2004)). The Expert Panel used these reports
as a framework for development of the integrated format. A systematic review of
the evidence was conducted to address a broad array of questions concerning the
development, progression, and management of multiple CV risk factors extending from
before birth to 21 years of age. This review required assessing all the evidence
pertaining to the role of risk factors in childhood on the development and progression
of atherosclerosis from childhood and adolescence to adulthood, as well as the body
of evidence that addresses the impact of managing risk factors in childhood on the
development and progression of atherosclerosis. Based on the assembled evidence,
the Expert Panel developed graded, age-specific recommendations that are integrated
across risk factors and across age groups.
In developing these comprehensive evidence-based Guidelines addressing all of the
major risk factors, the panel has provided a practical approach to both the optimization
of CV health and the management of identified risk factors throughout childhood
and adolescence, a time when many health-behavior patterns develop and when risk
reduction should have the greatest impact. These Guidelines should be of use to
all those who provide health care to children to help them reduce future CV morbidity
and mortality. By addressing the major population-based risk factors for CVD in
children and adolescents, these guidelines will support pediatric care providers
in optimizing CV health in infancy, early childhood, and adolescence-developmental
periods when many health behavior patterns develop, risk factors may become evident,
and risk reduction should have the greatest impact.
This Full Report of the Guidelines and the evidence tables will be available on
the NHLBI Web site under "Pediatric Cardiovascular Risk Reduction Initiative" at
http://www.nhlbi.nih.gov/guidelines/cvd_ped/index.htm.
A Summary Report containing the conclusions of the evidence review and the recommendations
has been prepared and is being published as a supplement in the December 2011 issue
of the journal Pediatrics. The Summary Report is also available on the
NHLBI Web site. Release of the Guidelines will be followed by dissemination and
implementation activities.
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