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(ST. LOUIS) July 21, 2004 – Although they may not strike until middle age or later, heart attack and stroke – two of the nation’s top three killers – are diseases that begin in childhood, according to Gautam K. Singh, M.D., director of the Preventive Cardiology Clinic at St. Louis Children’s Hospital (SLCH), and associate professor in pediatrics, Washington University School of Medicine.
Most of us start to think about our risk for heart attack, stroke and other cardiovascular diseases when we reach middle age, and many doctors do not order cholesterol tests or address other risk factors for these diseases until their patients are adults.
But for many, testing in adulthood may be too late.
Risk factors for arteriosclerosis – a buildup of plaque that clogs the arteries and is the major cause of heart attack, stroke and other vascular diseases – often are present in young children. The optimum way to prevent arteriosclerosis in high risk individuals is to intervene in childhood, according to Dr. Singh.
Dr. Singh’s philosophy is the driving force behind SLCH’s Preventive Cardiology Clinic, a unique new program offered by the hospital’s Division of Pediatric Cardiology.
The Preventive Cardiology Clinic works with children up to 18 years of age who are at high risk of developing cardiovascular disease. It’s a family affair – parents attend with their children, and each child is seen by a team of caretakers, including a cardiologist, nutritionist and nurse coordinator, who work with the family to implement changes that will improve cardiovascular health.
The clinic offers:
- A detailed medical, dietary and family history.
- A comprehensive physical exam.
- Tests such as an electrocardiogram (EKG) and blood tests for hyperlipidemia (high cholesterol) or other conditions that help determine a child’s risk of cardiovascular disease.
- Education and counseling for children and their families to encourage lifestyle changes such as exercise and diet that promote good health.
- Consultation with a nutritionist to develop healthy diets tailored to the family’s food preferences and lifestyle.
- Medical intervention with therapeutic agents, if indicated.
- Ongoing evaluation and follow up to monitor the child’s progress.
Some children may have risk factors that predispose them to the premature onset of coronary artery disease or other cardiovascular diseases. Once a child is age four or older, pediatricians and family physicians should screen children for risk factors as part of an annual physical examination and ask the following questions:
- Does the child have a family history of coronary artery disease or related conditions such as heart attack, stroke, high blood pressure, chest pain, treatment for clogged arteries in the legs or elsewhere, diabetes or hyperlipidemia (high cholesterol)? The risk is especially high if there is a family history of these diseases in individuals under age 55.
- Do the child’s parents have high cholesterol? (Total cholesterol above 200; LDL cholesterol above 130).
- Does the child have high blood pressure, diabetes or other risk factors, including obesity, an inactive lifestyle, or a family member who smokes? Does the child smoke?
- Is there a family history of sudden cardiac death?
As an example, Dr. Singh points out that as many as one-third of children age nine through 18 have high cholesterol, yet many pediatricians and family physicians do not routinely assess risk factors and perform cholesterol tests in children of this age. "We need to get the word out to parents, pediatricians and other physicians that children should be evaluated early in life to identify risk factors that often go unnoticed until adulthood," Dr. Singh said.
St. Louis Children's Hospital has provided specialized care for children for more than 125 years. Children's Hospital is affiliated with Washington University School of Medicine, ranked the second best medical school in the country by US News & World Report. Washington University is known for excellence in medical research, teaching and patient care. In 2003, Child magazine ranked St. Louis Children's Hospital sixth on its list of the 10 Best children's hospitals in the country, and fourth in neonatology/neonatal intensive care unit (NICU). St. Louis Children's Hospital also is a member of BJC HealthCare, the first fully integrated health-care system in the country to join an academic medical center with suburban, rural and metropolitan-based health-care facilities.