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Canadian Journal of Cardiology

Life-Course Implications of Pediatric Risk Factors for Cardiovascular Disease

Published:February 10, 2021DOI:https://doi.org/10.1016/j.cjca.2021.02.001

      Abstract

      The concept that origins of cardiovascular disease (CVD) begin in childhood is supported by substantial evidence. Prospective studies beginning in childhood report associations of childhood obesity, abnormal blood pressure (BP), dyslipidemia, diabetes, and tobacco use with intermediate CVD markers, including left ventricular hypertrophy and vascular stiffness in young adulthood. Trajectory analyses from longitudinal studies describe discrete BP pathways from childhood to young adult status of hypertension and prehypertension. Among individuals with familial hypercholesterolemia, abnormal low-density lipoprotein cholesterol levels are present in childhood. Some children are at risk for future CVD owing to hereditary factors, psychosocial stress, race, low birth weight, or other nonmodifiable exposures. Behavioural factors, including suboptimal diet, sedentary activity, and tobacco use, in childhood augment risk and can be modified to reduce risk. Pharmacologic treatments are reserved for those at high levels of the BP and cholesterol distributions and for those with diabetes and additional risk factors.

      Résumé

      L’idée selon laquelle les maladies cardiovasculaires (MCV) ont leur origine dans l’enfance est étayée par de nombreuses données. Des études prospectives amorcées durant l’enfance permettent d’établir un lien entre, d’une part, l’obésité, une pression artérielle (PA) anormale, la dyslipidémie, le diabète et le tabagisme chez l’enfant, et, d’autre part, des marqueurs intermédiaires de MCV tels que l’hypertrophie ventriculaire gauche et la rigidité vasculaire chez le jeune adulte. Des analyses de trajectoire provenant d’études longitudinales décrivent les voies silencieuses qu’emprunte la PA dès l’enfance pour évoluer vers la préhypertension ou l’hypertension chez le jeune adulte. Parmi les individus atteints d’hypercholestérolémie familiale, des concentrations anormales de cholestérol des lipoprotéines de basse densité sont observées dès l’enfance. Certains enfants sont susceptibles d’être atteints plus tard de MCV à cause de facteurs comme l’hérédité, le stress psychosocial, la race, un faible poids à la naissance ou d’une exposition à d’autres éléments non modifiables. Les facteurs comportementaux durant l’enfance, tels qu’un régime alimentaire non optimal, des activités sédentaires et le tabagisme, augmentent le risque, mais il est possible de modifier ces facteurs de manière à diminuer le risque. Les traitements pharmacologiques sont réservés aux individus dont les valeurs de la PA et les concentrations de cholestérol sont élevées ainsi qu’à ceux qui sont atteints de diabète et qui ont d’autres facteurs de risque.
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