Introduction: Achieving ideal cardiovascular health (iCVH) for children necessitates both public health and clinic-based interventions. In a pediatric population referred for dyslipidemia, we aimed to describe the change in iCVH metrics after clinic-based lifestyle counseling. We hypothesized that children referred to a preventive cardiology clinic would show improvement in iCVH factors during clinical care.
Methods: We analyzed data from children ages 8-19 years seen for two consecutive visits in the Boston Children’s Hospital Preventive Cardiology clinic between 2010-2014. Height, weight, blood pressure, fasting cholesterol, and fasting glucose were measured using standard clinic and laboratory protocols; smoking, diet, and physical activity patterns were self-reported. We used the AHA definitions of ideal, intermediate, and poor iCVH with minor adaptations (Figure). Each iCVH score had a possible range of 0 (poor) to 2 (ideal); the corresponding total iCVH score could range from 0 (all poor) to 14 (all ideal).
Results: We included 351 children in this analysis (mean [SD] age 13.4 [IQR 10.9-16.3] years, 54% female). Few patients met all 7 ideal factors at baseline (n=2) or follow-up (n=4). Over an average of 3 [IQR 0.5-5.9] months from initial assessment to first follow-up, mean (SD) iCVH score improved from 8.3 (2.5) to 8.7 (2.4) (p-value<0.001). Only 28% of patients had ideal or intermediate cholesterol at baseline; this improved to 38% at the follow-up visit (p<0.001 for comparison). Improvement was seen in all 7 iCVH metrics; changes in the smoking, diet, and cholesterol metrics were statistically significant.
Conclusion: Subspecialty care can improve the iCVH of children who present with low-intermediate levels. Further work is needed to determine the long term scalability of cardiovascular health promotion efforts in pediatric care.