Burke G L, Cresanta J L, Shear C L, Miner M H, Berenson G S
Cardiol Clin. 1986 Feb;4(1):33-46.
Normal levels and trends of cardiovascular disease risk factors in childhood have been well documented by numerous epidemiologic surveys. Expected levels of blood pressure, lipids and lipoproteins, and body size can be determined by the child's physician using race- and gender-specific grids. These grids allow for the identification and follow-up of children with high-risk profiles. Evidence of increased left ventricular mass and vascular changes in renal arteries in association with childhood blood pressure level along with atherosclerotic fatty streak and fibrous plaque development in the aorta and coronary arteries shows that children with elevated risk factors are at risk for early target organ damage. These data demonstrate the potential importance of early intervention on the natural history of cardiovascular disease. Based on our own data from the Bogalusa population, as well as evidence from other epidemiologic investigations in children, the following recommendations can be made, regardless of the risk factor variable under consideration: Cardiovascular disease risk factor variables should be measured carefully and in a serial manner to classify a child as abnormal. Serial measurements serve to reduce the effect of regression to the mean and increase the predictive value of the measurements. The misclassification of normal children into the high-risk category can be avoided by serial and replicate observations. Interventions that have attendant side effects (for example, pharmacologic therapy for high blood pressure) have to be measured against the effectiveness of diet, exercise, and other aspects of primary prevention. Risk factor levels consistently greater than the ninetieth percentile deserve medical attention. Care should be taken prior to using specific grids of normal levels of cardiovascular disease risk factors in children. The measurement techniques employed on individuals should be similar to those used by the epidemiologic study to generate the grids in a reference population. The grids should become part of the child's permanent medical record, as they provide a rapid visual assessment of the cardiovascular disease risk profile over time. High-risk trackers may require more intensive follow-up and will allow for early intervention and an assessment of the efficacy of the intervention program. In conclusion, cardiovascular disease risk factor screening in childhood is quick, effective, and inexpensive. The potential payoff in prevention of adult cardiovascular disease is enormous and allows the physician to provide more comprehensive care to a pediatric population.
众多流行病学调查已充分记录了儿童心血管疾病危险因素的正常水平及趋势。儿童的医生可利用种族和性别特异性网格来确定血压、血脂和脂蛋白以及体型的预期水平。这些网格有助于识别和跟踪具有高危特征的儿童。与儿童血压水平相关的左心室质量增加和肾动脉血管变化的证据，以及主动脉和冠状动脉中动脉粥样硬化脂肪条纹和纤维斑块的发展表明，危险因素升高的儿童存在早期靶器官损害的风险。这些数据证明了早期干预对心血管疾病自然病程的潜在重要性。根据我们在博加卢萨人群中的自身数据以及其他儿童流行病学调查的证据，无论考虑何种危险因素变量，均可提出以下建议：应仔细且连续地测量心血管疾病危险因素变量，以便将儿童分类为异常。连续测量有助于减少均值回归的影响，并提高测量的预测价值。通过连续和重复观察可避免将正常儿童误分类为高危类别。对于有伴随副作用的干预措施（例如高血压药物治疗），必须与饮食、运动和其他一级预防方面的效果进行权衡。危险因素水平持续高于第90百分位数值得医学关注。在使用儿童心血管疾病危险因素正常水平的特定网格之前应谨慎。个体所采用的测量技术应与流行病学研究在参考人群中生成网格时所使用的技术相似。这些网格应成为儿童永久病历的一部分，因为它们可随时间快速直观地评估心血管疾病风险状况。高危追踪者可能需要更密集的随访，并将允许早期干预以及评估干预计划的效果。总之，儿童心血管疾病危险因素筛查快速、有效且成本低廉。预防成人心血管疾病的潜在收益巨大，并且使医生能够为儿科人群提供更全面的护理。
