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Pediatric preventive cardiology: experience in the Tidewater, Virginia area
1Eastern Virginia Medical School, Norfolk.
Insights
A new pediatric cardiology program improved cholesterol levels in children through diet and medication. This initiative aims to reduce the long-term risk of coronary artery disease.
Area of Science:
- Pediatric Cardiology
- Preventive Cardiology
- Public Health
Background:
- American Academy of Pediatrics (AAP) guidelines recommend pediatric cholesterol screening.
- Local pediatricians are not consistently following the AAP's "family history" approach.
- Most pediatricians screen all patients for cholesterol abnormalities, irrespective of family history.
Purpose of the Study:
- To establish a preventive cardiology program addressing pediatric hyperlipidemia.
- To evaluate the effectiveness of dietary interventions and medication in hyperlipidemic children.
- To assess pediatrician adherence to AAP cholesterol screening recommendations.
Main Methods:
- Implementation of public and physician educational programs.
- Dietary treatment program for hyperlipidemic children.
- Case study of nine patients treated with cholestyramine.
Main Results:
- Dietary program reduced mean total cholesterol by 10% and LDL by 9.3%.
- Cholestyramine treatment resulted in greater reductions: 16% in total cholesterol and 19% in LDL.
- All observed changes were statistically significant (p < 0.05).
Conclusions:
- The preventive cardiology program shows promising short-term results in managing pediatric hyperlipidemia.
- Dietary interventions and cholestyramine are effective in lowering cholesterol levels in children.
- These findings support efforts to decrease the incidence of coronary artery disease from childhood.
Abstract:
The Division of Pediatric Cardiology began a preventive cardiology program in response to the American Academy of Pediatrics (AAP) Nutrition Committee recommendations on pediatric cholesterol screening. This program has consisted of both public and physician educational programs as well as the treatment of individual hyperlipidemic children. A survey of 67 local pediatricians has revealed that they have not followed the AAP directive for a "family history" approach to pediatric cholesterol screening, with most pediatricians screening all their patients for cholesterol abnormalities. Our dietary treatment program for hyperlipidemic children has given good short-term results, lowering mean total cholesterol concentrations by 10% (23 mg/dl) and mean low density lipoprotein cholesterol (LDL) concentrations by 9.3% (16 mg/dl), as well as decreasing the total cholesterol/high density lipoprotein cholesterol (HDL) ratio by 10% (0.6). The additional use of cholestyramine in nine selected patients has effected even greater mean value decreases of 45 mg/dl or 16% (total cholesterol), 44 mg/dl or 19% (LDL), and 1.3 or 19% (total cholesterol/HDL ratio). All these changes are statistically significant (p less than 0.05). These encouraging short-term results hopefully will promote the long-term goal of decreasing the incidence of coronary artery disease, which remains the leading cause of death in our country.