Updated AHA Scientific Statement Addresses CV Risk Reduction in High-Risk Youth

The American Heart Association (AHA) has released an updated scientific statement to help guide clinicians treating children and adolescents who have a high risk for premature CVD.

The document incorporates new evidence that has been accumulated on CV risk factors and the development heart disease in pediatric populations since the previous AHA scientific statement on this topic was published in 2006.

Sarah de Ferranti, MD (Boston Children’s Hospital, MA), chair of the writing group, told TCTMD some of the key areas with emerging data are the impact of severe versus more moderate obesity, the importance of familial hypercholesterolemia and its treatment, and the adverse effects associated with type 2 diabetes, which has become more common.

The purpose of the statement, published online February 25, 2019, ahead of print in Circulation, is to be a resource to help clinicians make sense of existing evidence on the management of young, high-risk patients. Pediatric data often don’t reach the level of evidence required for a formal guideline, de Ferranti pointed out.

“Part of the difficulty about pediatrics is that the types of studies we need aren’t always available, but we still have to take care of our patients,” she said. “So what we like to do is have some ways in which people might think about caring for their patients. Even if they can’t rely on a guideline per se, they can have the ear of an expert. And so what this paper is is more the ear of an expert.”

The bulk of the statement consists of discussions about characteristics that place children and adolescents at high risk for developing premature CVD, including traditional CV risk factors (familial hypercholesterolemia, obesity, type 1 and type 2 diabetes, and hypertension), diagnosed high-risk medical conditions (chronic kidney disease, chronic inflammatory diseases, and cancer), and “vulnerable heart” conditions (congenital heart disease or coronary anomalies, Kawasaki disease, and heart transplantation).

The focus is on management of CV risk, and the paper includes a figure describing an algorithm for risk stratification and treatment and a table with more detailed information.

“The overall approach of risk stratification and preferential use of pharmacotherapy to reduce CVD risk in the highest-risk individuals, with a foundation in heart-healthy therapeutic lifestyle change behaviors for all, is consistent with the guidelines for treatment of CVD risk in adults,” the authors write.

The document also includes references to other relevant statements and guidelines, patient resources, and areas in need of further research regarding the various conditions covered.

De Ferranti said one of the major points she’d like clinicians to take away from the updated statement is that there is a need to consider long-term CV risks in young patients with these high-risk conditions.

“Clinicians are doing this all the time but how to put these in context and how to manage these conditions, this document is supposed to be helpful for that,” she said. This information will likely need to be changed as the understanding of CV risks in pediatric populations improves, de Ferranti added, “but this is a good place for people who don’t have time to evaluate all of the literature independently to go and see what some experts think about how to care for and assess the cardiovascular risks of these patients.”