Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Preventive Cardiology-Lipid Clinic, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, New York, USA.
Can J Cardiol. 2020 Sep;36(9):1417-1428. doi: 10.1016/j.cjca.2020.06.025. Epub 2020 Jul 14.
Atherosclerosis in its earliest stages is associated with the same traditional cardiovascular disease (CVD) risk factors as are associated with manifest CVD events in adulthood. Clustering of risk factors is associated with exponential increases in atherosclerotic burden from a young age. Some medical conditions and risk behaviours occurring in children can either increase the likelihood of higher levels of risk factors (such as chronic kidney disease) or the presence of risk factor clustering (such as obesity and cardiometabolic syndrome) or are associated with acquired coronary artery pathology (such as Kawasaki disease). This creates a milieu for-or increases the impact of-accelerated atherosclerosis that, in turn, increases the likelihood of premature CVD. This review highlights the importance of considering the total risk factor and risk-condition profile of pediatric patients. An algorithm is provided for stratifying patients into high-, moderate-, and at-risk categories, and practical examples are provided as to how the evaluation and management of 1 risk factor or risk condition might need to be intensified in the context of additional risk factors or risk conditions. For example, for treatment of an adolescent with familial hypercholesterolemia, the target low-density lipoprotein cholesterol level might be lowered by the concomitant presence of low high-density lipoprotein cholesterol or elevated lipoprotein(a) levels. As awareness of cardiovascular risk and atherosclerosis in pediatric patients increases, new at-risk conditions that warrant consideration are emerging. The identification and management of high-risk individuals is an important part of the overall practice of pediatric preventive cardiology.
动脉粥样硬化在早期阶段与成年后明显的心血管疾病（CVD）事件相关的传统心血管疾病（CVD）危险因素有关。危险因素的聚集与动脉粥样硬化负担从年轻时开始呈指数级增加有关。一些在儿童中发生的医疗状况和风险行为，要么增加了更高水平的危险因素（如慢性肾脏病）或存在危险因素聚集（如肥胖和心血管代谢综合征）的可能性，要么与获得性冠状动脉病理学（如川崎病）有关。这为加速动脉粥样硬化创造了一个环境，或者增加了加速动脉粥样硬化的影响，进而增加了过早发生 CVD 的可能性。这篇综述强调了考虑儿科患者的总体危险因素和风险状况的重要性。提供了一种算法，将患者分为高、中、低风险类别，并提供了实用示例，说明在存在其他危险因素或风险状况的情况下，如何加强对 1 个危险因素或风险状况的评估和管理。例如，对于患有家族性高胆固醇血症的青少年，由于同时存在低高密度脂蛋白胆固醇或升高的脂蛋白（a）水平，可能需要降低目标低密度脂蛋白胆固醇水平。随着对儿科患者心血管风险和动脉粥样硬化认识的提高，新的需要考虑的高危疾病正在出现。识别和管理高危人群是儿科预防心脏病学整体实践的重要组成部分。
