Editor’s Note: Dr. Elif Ozdogan (she/her) is a resident physician in Pediatrics at The Boston Combined Residency Program at Boston Children's Hospital and Boston Medical Center. She is interested in quality improvement and computational research and hopes to pursue further training in Transplant Medicine. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
Atherosclerosis, which manifests as cardiovascular disease later in adulthood, begins early in life. Pediatricians thus emphasize healthy eating to prevent atherosclerosis in our young patients.
The natural question is: which patients are especially at risk of atherosclerosis and need targeted intervention?
In the article entitled “Predictors in Youth of Adult Cardiovascular Events,” being early released this week in Pediatrics, Drs. Joel Nuotio and Tomi Laitinen from University of Turku in Finland and colleagues sought to answer this question (10.1542/peds.2024-066736). They set out to understand if non-laboratory risk factors alone are enough to predict risk, or if lipid measurements are also needed. In order to do so, they combined seven childhood cohorts across Finland, Australia, and the US that together comprised 11,550 participants.
The authors developed 2 risk models using data at 12–19 years of age and compared their performance in predicting cardiovascular disease in adulthood (mean age, 50 years):
- The non-laboratory model included blood pressure, BMI, and history of smoking.
- The lipid model included total cholesterol and triglyceride in addition to blood pressure, BMI, and history of smoking.
- In both models as the number of risk factors increased the rate of cardiovascular events increased.
- Importantly, there was no significant difference between the models in predicting cardiovascular events in adulthood.
These findings are valuable and applicable. They provide strong support for easy and accessible office-based efforts that do not rely on lab monitoring. This could help encourage the primary care provider to follow the clinical risk factors more closely.
However, there is one caveat. In the accompanying commentary entitled “To Screen or Not to Screen: That is the Cholesterol Question,” Dr. Samuel Gidding from Geisinger helps us interpret the findings in the appropriate clinical context (10.1542/peds.2024-068548). Screening for familial hypercholesterolemia (FH) is another reason why cholesterol screening is important in the pediatric population. FH results from inherited changes to key proteins in the cholesterol pathway and affects 1:250 of the population. Relying only on family history falls short in identifying those with FH, while early identification and treatment provide significant benefits in outcome.
In their 2011 guidelines, the American Academy of Pediatrics and National Heart, Lung, and Blood Institute recommended universal lipid screening at ages 9–11 years and earlier screening for those with clinical risk factors. The reasoning for this holds true as we bring FH screening into the equation. However, it is empowering to see that the findings of a multinational, longitudinal cohort study support history and physical exam-based assessments.
The question “which patients are especially at risk of atherosclerosis” becomes “which patients benefit from knowing their cholesterol level.” As research continues to answer this question, I highly recommend reading the original article and its commentary to learn more about the data and the discussions.
