Improving Cardiovascular Health in a Pediatric Preventive Cardiology Practice

Gooding, Holly C.; Bachman, Jennifer; Baker, Annette L.; Griggs, Suzanne; Hartz, Jacob; Huang, Yisong; Mendelson, Michael; Palfrey, Hannah; Ferranti, Sarah D. de

doi:10.1016/j.jpeds.2021.01.070

Cited by 4 publications

(3 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…All patients were treated based on a typical clinical management plan outlined by Zachariah et al. and Gooding et al 12,14 . Patients referred to the preventive cardiology clinic were prospectively enrolled in this management plan, which is based on the 2011 National Heart, Lung, and Blood Institute (NHLBI) Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents 13 .…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Clinical response to lifestyle counseling for dyslipidemia and elevated blood pressure in childhood cancer survivors

Javalkar

Huang

Lyon

et al. 2022

Pediatric Blood & Cancer

Self Cite

View full text Add to dashboard Cite

Background Childhood cancer survivors (CCS) have increased risk of premature cardiovascular disease. Whether they respond similarly to lifestyle changes for elevated blood pressure (BP), body mass index (BMI), and dyslipidemia to those without history of childhood cancer is unknown. Procedure This retrospective cohort study included CCS and 3:1 age‐ and sex‐matched controls treated at Boston Children's Hospital Preventive Cardiology (2010–2019) using lifestyle management based on National Heart, Lung, and Blood Institute (NHLBI) guidelines. Change in BMI, BP, and lipids were analyzed. Results We included 52 CCS and 162 controls with a median age of approximately 16 years. More CCS (84.3%) had elevated baseline fasting triglycerides (TG) than controls (49.4%) (p < .001). More CCS (62.5%) also had abnormal baseline high‐density lipoprotein cholesterol (HDL‐C) compared to controls (35.2%) (p = .001). Baseline BMI, BP, total cholesterol (TC), and low‐density lipoprotein cholesterol (LDL‐C) were similar between groups. Over 15 weeks [IQR: 10.5–26], CCS had greater decrease in TG than controls (72.5 vs. 17 mg/dl decrease, p = .095). BP improved in 5% of CCS versus 38% of controls (p = .008). For both, BMI, TC, LDL‐C, and HDL‐C remained stable. CCS with stem cell transplantation (SCT) had a TC increase of 5% (6 mg/dl) compared to a decrease of 9% (19 mg/dl) among CCS without SCT (p = .02). Conclusions CCS demonstrated similar improvement in lipids, but impaired BP lowering in response to lifestyle management compared to controls. Further prospective studies are needed to determine if earlier pharmaceutical treatment is warranted in this higher risk population and for the long‐term risk reductions of these approaches.

show abstract

Section: Methodsmentioning

confidence: 99%

“…During the study period, 62 CCS were evaluated and treated in the preventive cardiology clinic. We excluded for CCS and 18 weeks [IQR: [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]] for controls (p = .10). Table 2 depicts cancer and treatment-related characteristics of the CCS group.…”

Section: Descriptive Characteristicsmentioning

confidence: 99%

Clinical response to lifestyle counseling for dyslipidemia and elevated blood pressure in childhood cancer survivors

Javalkar

Huang

Lyon

et al. 2022

Pediatric Blood & Cancer

Self Cite

View full text Add to dashboard Cite

show abstract

“…61,64 Among health education interventions, those with multiple sessions demonstrated better results compared with a single-session intervention. 63,72,73,85,86 Although individual variation certainly exists, there appears to be a minimum intervention intensity required to achieve a change in CVH.…”

Section: Outcomes Related To Child and Adult Cvhmentioning

confidence: 99%

Life Course Cardiovascular Health: Risk Factors, Outcomes, and Interventions

Pedamallu¹,

Zmora²,

Perak

et al. 2023

Circulation Research

View full text Add to dashboard Cite

Since it was first defined by the American Heart Association in 2010, cardiovascular health (CVH) has been extensively studied across the life course. In this review, we present the current literature examining early life predictors of CVH, the later life outcomes of child CVH, and the relatively few interventions which have specifically addressed how to preserve and promote CVH across populations. We find that research on CVH has demonstrated that prenatal and childhood exposures are consistently associated with CVH trajectories from childhood through adulthood. CVH measured at any point in life is strongly predictive of future cardiovascular disease, dementia, cancer, and mortality as well as a variety of other health outcomes. This speaks to the importance of intervening early to prevent the loss of optimal CVH and the accumulation of cardiovascular risk. Interventions to improve CVH are not common but those that have been published most often address multiple modifiable risk factors among individuals within the community. Relatively few interventions have been focused on improving the construct of CVH in children. Future research is needed that will be both effective, scalable, and sustainable. Technology including digital platforms as well as implementation science will play key roles in achieving this vision. In addition, community engagement at all stages of this research is critical. Lastly, prevention strategies that are tailored to the individual and their context may help us achieve the promise of personalized prevention and help promote ideal CVH in childhood and across the life course.

show abstract