小児・青年期: 心血管健康リスク減少のための集約的ガイドライン専門委員会

コレステロールチェックを子供全員で行うべきというAAP(アメリカ小児医学会)の推奨
9-11歳、17-21歳で一度は検査されるべきで、すべての心血管疾患リスク要素に対する包括的ガイドとして推奨、AHAにて報告され、AAP雑誌でオンライン掲載

動脈硬化は子供の頃から始まっているという認識、両親・兄弟も関与しているという認識など・・・


10歳以上で、ライフスタイル修正6ヶ月以上変化無しの160-189mg/dl、LDL 190mg/dL以上で薬物考慮などが記載。


・たばこに関する指導
・減量に関する項目
・3歳でルーチン血圧測定
・テレビ・PCなどスクリーンタイムは2時間以下に制限
・血糖を9-11歳で検査開始
など・・・

Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report

The American Academy of Pediatrics Dec. 2011. Vol.128 Sup. 5

心血管系健康増進のための家族歴利用エビデンスベース推奨
Birth to 18 y
・Take detailed family history of CVD at initial encounter and/or at 3, 9–11, and 18 ya Grade B Recommend

・If positive family history identified, evaluate patient for other cardiovascular risk factors, including dyslipidemia, hypertension, DM, obesity, history of smoking, and sedentary lifestyle If positive family history and/or cardiovascular risk factors identified, evaluate family, especially parents, for cardiovascular risk factors
Grade B Recommend

・Update family history at each nonurgent health encounter Grade D Recommend

・Use family history to stratify risk for CVD risk as risk profile evolves Grade D Recommend


Supportive action: educate parents about the importance of family history in estimating future health risks for all family members



18 to 21 y
・ Review family history of heart disease with young adult patient Grade B Strongly recommend

Supportive action: educate patient about family/personal risk for early heart disease, including the need for evaluation for all cardiovascular risk factors


Evidence-Based Recommendations for Diet and Nutrition: CHILD-1

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Evidence-Based Activity Recommendations for Cardiovascular Health

Age-Specific Recommendations for BP Measurement and Diagnosis of
Hypertension

Conditions Under Which Children <3 Years Old Should Have BP Measured

BP Norms for Boys by Age and Height Percentile

Antihypertensive Medications With Pediatric Experience Class Drug Initial Dosea Maximal Dose

Acceptable, Borderline-High, and High Plasma Lipid, Lipoprotein, and Apolipoprotein Concentrations for Children and Adolescents

Recommended Cut Points for Lipid and Lipoprotein Levels in Young Adults

BP measurement and categorization

BP management according to category.

Summary of Major Lipid Disorders in Children and Adolescents

Evidence-Based Recommendations for Lipid Assessment

Risk-Factor Definitions for Dyslipidemia Algorithms

Special Risk Conditions

Evidence-Based Recommendations for Dietary Management of Elevated LDL Cholesterol, Non-HDL Cholesterol, and Triglyceride Levels Dyslipidemia algorithm

Evidence-Based Recommendations for Dietary Management of Elevated LDL
Cholesterol, Non-HDL Cholesterol, and Triglyceride Levels

Medications for Managing Hyperlipidemia

Clinical Trials of Lipid-Lowering Medication Therapy in Children and Adolescents

Recommendations for Use of 3-Hydroxy-3-Methylglutaryl-Coenzyme A Reductase Inhibitors (Statins) in Children and Adolescents

American Diabetes Association (ADA) Screening Recommendations for Type 2

Special Risk Pediatric Conditions: Stratification by Risk Category 

Risk stratification and management for children with conditions predisposing to accelerated atherosclerosis and early CVD
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Condition-Specific Treatment Recommendations for High-Risk Conditions

Metabolic Syndrome Component Levels for Evaluation of Children With Multiple
Cardiovascular Risk Factors

Evidence-Based Recommendations for Management of Overweight and Obesity

Evidence-Based Recommendations for Maternal Smoking Cessation

Evidence-Based Recommendations for Management of Overweight and Obesity

by internalmedicine | 2011-11-12 08:38 | 動脈硬化/循環器  

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