Expert Panel on Integrated Guidelines for Cardiovascular ...

1 National Heart, Lung, and Blood Institute Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents FULL REPORT. National Heart, Lung, and Blood Institute Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents Full Report NIH Publication No. 12-7486. October 2012. Expert Panel Membership Stephen R. Daniels, , , Panel Chair Peter O. Kwiterovich, University of Colorado School of Medicine Johns Hopkins University School of Medicine Denver, CO Baltimore, MD.

2 Irwin Benuck, , Patrick E. McBride, , Northwestern University Feinberg School University of Wisconsin School of Medicine and of Medicine Public Health Chicago, IL Madison, WI. Dimitri A. Christakis, , Brian W. McCrindle, , University of Washington The Hospital for Sick Children Seattle, WA Toronto, ON. Barbara A. Dennison, Albert P. Rocchini, New York State Department of Health Mott Children's Hospital Albany, NY Ann Arbor, MI. Samuel S. Gidding, Elaine M. Urbina, Alfred I duPont Hospital for Children Cincinnati Children's Hospital Medical Center Wilmington, DE Cincinnati, OH.

3 Matthew W. Gillman, , Linda V. Van Horn, , Harvard Pilgrim Health Care Northwestern University Feinberg School of Boston, MA Medicine Chicago, IL. Mary Margaret Gottesman, , , Ohio State University College of Nursing Reginald L. Washington, Columbus, OH Rocky Mountain Hospital for Children Denver, CO. ii Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents Full Report NHLBI Staff Rae-Ellen W. Kavey, , Panel Coordinator National Heart, Lung, and Blood Institute Bethesda, MD.

4 Christopher J. O'Donnell, , National Heart, Lung, and Blood Institute Framingham, MA. Karen A. Donato, National Heart, Lung, and Blood Institute Bethesda, MD. Robinson Fulwood, , National Heart, Lung, and Blood Institute Bethesda, MD. Janet M. de Jesus, , National Heart, Lung, and Blood Institute Bethesda, MD. Denise G. Simons-Morton, , , National Heart, Lung, and Blood Institute Bethesda, MD. Contractor Support The Lewin Group, Falls Church, VA. Clifford Goodman, , Christel M. Villarivera, Charlene Chen, Erin Karnes, Ayodola Anise, Expert Panel Membership iii Relationship/Conflict of Interest/Financial/.

5 Other Disclosures Expert Panel members disclosed relevant financial Dr. McBride has served as a consultant or interests to each other prior to discussions. The advisory board member for Bristol-Myers Squibb following financial interests are reported in the and Merck. He has served on speakers bureaus for publication in the Journal of Pediatrics: Kos, Merck, and Pfizer. He declared no relevant relationships since July 2007. Dr. Benuck, Dr. Christakis, Dr. Dennison, Dr. O'Donnell, Dr. Rocchini, and Dr. Washington have Dr. McCrindle has been a consultant for Abbott, declared no relevant relationships.

6 Bristol-Myers Squibb, Daichii Sankyo, and Roche. He owns stock in CellAegis. He reports funding/. Dr. Daniels has served as a consultant for Abbott grant support for research from Astra Zeneca, Laboratories, Merck, and Schering-Plough. He has Sankyo, Merck, Schering-Plough, and the NIH. received funding/grant support for research from the NIH. Dr. Urbina reports funding/grant support for research from Merck, Schering-Plough, Sankyo, Dr. Gidding has served as a consultant for Merck and the NIH. and Schering-Plough. He has received funding/.

7 Grant support for research from GlaxoSmithKline. Dr. Van Horn has provided advice to Chartwells School Food Service. She has received funding/. Dr. Gillman has given invited talks for Nestle grant support for research from General Mills Nutrition Institute and Danone. He has received and the NIH. funding /grant support for research from Mead Johnson, Sanofi-aventis, and the NIH. Dr. Gottesman has served on the Health Advisory Board, Child Development Council of Franklin County. She was a consultant to Early Head Start for Region 5B.

8 She has written for iVillage and taught classes through Garrison Associates for the State of Ohio, Bureau of Early Intervention Services, and Help Me Grow program. She has received funding /grant support for research from the NIH. Dr. Kwiterovich has served as a consultant or advi- sory board member for Merck, Schering-Plough, Pfizer, Sankyo, LipoScience, and Astra Zeneca. He has served on speaker bureaus for Merck, Scher- ing-Plough, Pfizer, Sankyo, Kos, and Astra Zeneca. He has received funding/grant support for research from Pfizer, Merck, GlaxoSmithKline, Sankyo, and Schering-Plough.

9 Iv Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents Full Report Contents Background .. vi 1. Introduction .. 1. 2. State of the Science: Cardiovascular Risk factors and the Development of Atherosclerosis in Childhood .. 7. 3. Screening for Cardiovascular Risk factors .. 22. 4. Family History of Early Atherosclerotic Cardiovascular Disease .. 28. 5. Nutrition and Diet .. 33. 6. Physical Activity .. 64. 7. Tobacco Exposure .. 71. 8. High Blood Pressure .. 78. 9. Lipids and Lipoproteins.

10 94. 10. Overweight and Obesity .. 141. 11. Diabetes Mellitus and Other Conditions Predisposing to the Development of Accelerated Atherosclerosis .. 160. 12. Risk Factor Clustering and the Metabolic Syndrome .. 168. 13. perinatal factors .. 173. 14. Inflammatory Markers .. 177. 15. Integrated Cardiovascular Health Schedule .. 178. 16. Implications of the Guidelines for Public Policy, Reimbursement, Medical Education, and Research .. 179. Appendix A. Methodology .. 181. Contents V. Background In 2005, based on recommendations from the clinical endpoint of manifest CVD is much experts convened in a national Thought Leaders later in life.