Cresanta J L, Burke G L, Downey A M, Freedman D S, Berenson G S
Pediatr Clin North Am. 1986 Aug;33(4):835-58. doi: 10.1016/s0031-3955(16)36076-x.
Atherosclerosis begins in infancy, with fatty streaks appearing at the age of 3 years and fibrous plaques appearing during adolescence. Fatty streaks and fibrous plaques are related to serum total cholesterol, LDL-C, and systolic blood pressure levels. Children with elevated levels of cholesterol and blood pressure track (i.e., maintain elevated levels over time) and are candidates for premature coronary artery and cerebrovascular disease, especially if there is a positive family history of premature CVD. Screening for CVD risk factors in children is rapid, simple, inexpensive, and effective, with tremendous potential to prevent future adult CVD. At their annual physical examinations, children 5 years of age or older should have careful blood pressure measurements by two observers, and determinations of serum total cholesterol levels. Levels should be plotted on standard percentile grids (Figs. 5-7) in the child's permanent medical record. Those with persistently elevated levels of blood pressure and/or serum LDL-C require nonpharmacologic intervention initially, but may require antihypertensive or antilipid medication if unresponsive to behavioral modification for diet, physical activity, and cigarette smoking. Pediatric health professionals can play vital roles in primary prevention and reduction of adult CVD.
动脉粥样硬化始于婴儿期，3岁时出现脂肪条纹，青春期出现纤维斑块。脂肪条纹和纤维斑块与血清总胆固醇、低密度脂蛋白胆固醇及收缩压水平有关。胆固醇和血压水平升高的儿童会持续保持（即随着时间推移保持升高水平），并有可能患早发性冠状动脉和脑血管疾病，尤其是如果有早发性心血管疾病的家族史阳性。对儿童心血管疾病危险因素进行筛查快速、简单、廉价且有效，对预防未来成人心血管疾病具有巨大潜力。在年度体检时，5岁及以上儿童应由两名观察者仔细测量血压，并测定血清总胆固醇水平。这些水平应绘制在儿童永久病历中的标准百分位数网格上（图5 - 7）。血压和/或血清低密度脂蛋白胆固醇水平持续升高的儿童最初需要非药物干预，但如果对饮食、体育活动和吸烟的行为改变无反应，可能需要抗高血压或抗血脂药物。儿科健康专业人员在成人心血管疾病的一级预防和减少方面可发挥至关重要的作用。
