Prevention starts from the crib: the pediatric point of view on detection of families at high cardiovascular risk

Abstract

Background Cardiovascular disease (CVD) is one of the main causes of mortality and morbidity in Italy. Hypercholesterolemia is a modifiable CVD risk factor. The detection and treatment of hypercholesterolemia can modify the natural history of CVD, making CVD risk for affected patients comparable to that of unaffected ones. In this scenario, the detection of families at high cardiovascular risk is the first step of CVD prevention. This multicenter, observational study is aimed at finding an effective and non-invasive screening strategy to detect families at high risk for CVD. Methods A survey investigating the knowledge of lipid and CVD issues was distributed to the parents of all infants born at the Neonatology Unit of Piacenza City Hospital and San Paolo Hospital in Milan over a 6 months period. Overall, 554 surveys have been collected. Results 26.8% newborns had parents who knew their own lipid profile, 40.2% had parents who knew the correct normal blood values of total cholesterol, 37.1% had parents who declared to have first or second degree relatives with lipid disorders, 33.7% had parents who declared to have first or second degree relatives with premature CVD Conclusion Collecting a problem-tailored and accurate family history seems to be a good strategy to detect high risk families. Our data suggest that the percentage of adults who are unaware of their lipid profile, with a positive family history for CVD and/or lipid disorders is higher than expected. As a result, even the number of undetected paediatric patients at high cardiovascular risk might be greater than expected.

Nutritional Approach to Prevention and Treatment of Cardiovascular Disease in Childhood

“…Phenotypic expression of FH typically occurs in adulthood, so the detection of affected children and adolescents must be based on screening strategies. Unfortunately, knowledge of the "cholesterol problem" is still really poor in the general population, especially among young adults [12]. Lipoprotein(a) is a strong, genetically defined CHD risk factor.…”

Detecting Familial hypercholesterolemia in children and adolescents: potential and challenges

“…In Italy, every child should have a family doctor, that is to say a dedicated paediatrician that follows the child from birth to adolescence not only for illnesses, but also for growth and neurodevelopmental monitoring and for non communicable disease prevention. In this context, the collection of a detailed and problem tailored family history for cardiovascular events in first and second degree relatives is a fundamental milestone for cardiovascular disease prevention, so as the detection of children at high cardiovascular risk and the prescription of a lipid profile for these children [ 19 ].…”

“…The start of atherosclerosis prevention early in childhood is likely to result in a greater reduction in CVD morbidity and mortality than that achieved with current efforts aimed at preventing events in older adults [ 19 ].…”

Nutritional Treatment in a Cohort of Pediatric Patients with Familial Hypercholesterolaemia: Effect on Lipid Profile

“…The aim of this approach is to teach children and their families correct nutritional habits that can become a lifelong habit and last until adulthood [ 6 ]. Parents of children with hypercholesterolaemia often underestimate its effects as well as the CHD issue; as a consequence, thorough nutritional and lifestyle counseling for the whole family is an issue of utmost importance [ 7 ].…”