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Published on: September 26, 2018
Prediction of atherosclerotic cardiovascular risk in early childhood
Simona Ferraro1, Sara Benedetti2, Savina Mannarino3
1Center of Functional Genomics and Rare Diseases Dept. of Pediatrics Buzzi Children's Hospital, Milan, Italy; Pediatric Department, Buzzi Children's Hospital, Milan, Italy.
Insights
Early cardiovascular disease risk stratification in children is crucial. Integrating clinical, biochemical, and genetic data helps identify youth at risk for future cardiovascular events, enabling timely prevention.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Disease Prevention
- Biomarker Discovery
Background:
- Atherosclerotic lesions are evident in early childhood, necessitating pediatric cardiovascular disease risk assessment.
- Current strategies lack comprehensive approaches for identifying children at high risk for future cardiovascular events.
Purpose of the Study:
- To review and appraise clinical, biochemical, and genetic biomarkers for pediatric cardiovascular risk stratification.
- To propose an integrated algorithm for identifying children at risk of accelerated atherosclerosis and future cardiovascular events.
Main Methods:
- Critical appraisal of existing clinical, biochemical (lipid profile, Lipoprotein(a)), and genetic (monogenic dyslipidemias, polygenic risk scores) biomarkers.
- Evaluation of clinical conditions (obesity, diabetes mellitus, Kawasaki disease) and family history in children aged 2-5 years.
Main Results:
- Specific clinical conditions and family history are key indicators of accelerated atherosclerosis in young children.
- Lipid profiles and Lipoprotein(a) levels are recommended for children with elevated baseline risk.
- Genetic testing can identify monogenic dyslipidemias, indicating high genetic cardiovascular risk.
Conclusions:
- A holistic strategy integrating clinical, biochemical, and genetic data is essential for effective cardiovascular risk stratification in early childhood.
- Early identification and intervention are critical for preventing future cardiovascular events in at-risk children.
Abstract:
Atherosclerotic lesions are present even in very young individuals and therefore, risk stratification for cardiovascular (CV) disease should be implemented in childhood to promote early prevention strategies. In this review we critically appraise clinical, biochemical and genetic biomarkers available for pediatric clinical practice, which might be integrated to build effective algorithms to identify children at risk of future CV events. The first critical issue is to characterize in children aged 2-5 years, those CV risk factors/clinical conditions associated with dramatically accelerated atherosclerosis. Presence of clinical conditions such as obesity, diabetes mellitus, Kawasaki disease, etc., or positive family history for premature CV disease should be evaluated. Subsequently, a complete lipid profile and Lipoprotein(a) determination are recommended for children with increased baseline CV risk. Individuals with altered lipid profile could then undergo genetic testing for monogenic dyslipidemias to identify children with high CV genetic risk, who will be directed to appropriate therapeutic options. In perspective, calculation of a polygenic risk score, based on the analysis of several common single-nucleotide polymorphisms, could be integrated for better risk assessment. We here emphasize the importance of a "holistic" strategy integrating biochemical, anamnestic and genetic data to stratify CV risk in early childhood.
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