Reduction of Risk for Cardiovascular Disease in Children

Does atherosclerosis begin in childhood? Which kind of exercise is better for cardiovascular health?

How much screen time is healthy for children?


Cardiovascular (CVD) and circulatory diseases are now recognized as the leading causes of death in the world.  The majority of these CVD deaths were attributable to either ischemic heart disease (IHD) or cerebrovascular disease. In 2011 Member states of the United Nations voluntarily agreed to work  to  reduce  the  risk  of  premature  (defined  by  the  World  Health  Organization  as  occurring  from  ages  30  to  70  years)  death from CVD and diabetes mellitus, by 25% by 2025.


Although manifest disease in childhood and adolescence is rare, risk factors and risk behaviors that accelerate the development of atherosclerosis begin in childhood, and there is increasing evidence that risk reduction delays progression toward clinical disease. Children who are first‐degree relatives of subjects with premature clinical atherosclerosis have been shown to have higher cardiovascular risk. In future, this group may be the target of particular intervention strategies


An important current trend that may increase the future burden of CVD is a significant increase in the prevalence of childhood obesity. Childhood obesity has reached epidemic proportions worldwide and not only are children presenting with risk factors for later disease, they are often now diagnosed with what were traditionally considered to be adult diseases, such as type 2 diabetes.


The US Department of Health and Human Services for young people recommends that school students achieve a target of 60 minutes of daily exercise. However, as noted in adults, the activity observed in school children is far lower; only 7% engage in vigorous physical activity for 60 min per day, and only 26% reach the standard of 120 min/day of total activity. Exercise can be broadly categorized in four ways: dynamic (isotonic) or static (isometric), and, within each of these categories, dependent on either aerobic or anaerobic metabolism. Dynamic exercise involves repetition of low-resistance motion such as running, walking, swimming, cycling, cross-country skiing, aerobic dancing, and elliptical training. Static exercise involves sustained contraction of skeletal muscles against fixed resistance as hand grip, leg extension, and weight lifting. Associations for isometric muscle strength and cardiorespiratory fitness with these outcomes appeared additive, which indicate that it may be beneficial to increase muscle strength at any level of cardiorespiratory fitness.


Prolonged TV- and total screen time viewing during leisure time in adolescence, and increases in these behaviors, were associated with unfavorable levels of several risk factors for CVDs in young adulthood. Using all available prospective studies, prolonged TV viewing time was consistently associated with greater risk of T2D, fatal or non-fatal CVD and mortality from all-causes in a dose-response manner. Each 2 hours/day difference in TV viewing time increase the risk of CVD by 15%. In 2013 the US Department of Health recommended that children under two years of age should not be in front of a screen at all, and over that age the maximum leisure screen time should be no more than two hours a day.


Solid fats and added sugars (i.e “snack” foods, sugar-sweetened beverages, and desserts) are always counted as nonessential calories. Due to the sedentary behavior of most children, few such foods should be consumed, typically no more than 100–200 calories/day (kcal/d) as part of total energy intake in addition to minimisation of salt intake.


Because of the potential consequences associated with obesity, it is vital for parents and health care professionals to identify children at risk and provide appropriate help as needed. To reduce the future burden of CVD, we need to define prevention and intervention strategies that decrease the prevalence of cardiovascular risk factors in children and young adults. The main strategies for prevention and treatment of overweight and obesity in childhood are dietary modification reducing prolonged screen time viewing and increased physical activity and this approach can be adopted and maintained throughout life.


Do not forget what is has been said previously. Treatment must always be individualised, that is, adjusted to your particular case. Therefore, we recommend medical supervision before any change in your treatment or daily habits.