Abnormal cholesterol and high blood pressure are well-recognized conditions in adults. It surprises many people that these conditions can also arise in childhood, and that they lay the foundation for heart disease in adulthood. Research shows that normalizing cholesterol values and reducing high blood pressure in children may help prevent or slow the development of heart disease as they reach adulthood.
For more than 30 years, the Preventive Cardiology Clinic at Boston Children’s Hospital has offered state-of-the-art services aimed at identifying and medically managing the risk factors—particularly abnormal cholesterol and blood pressure often related to excess weight—that lead to cardiac events in adulthood. Its goals are to prevent heart attack, stroke and other acute cardiac events later in life; to decrease mortality; and to increase a child's future quality of life. We're the first and largest clinical service of this kind in the Northeast—highly experienced in evaluating and treating heart disease risk factors in children.
The Preventive Cardiology Clinic at Boston Children’s is the only clinical service in the Northeast that focuses on preventing heart disease in children. We take a multidisciplinary, team approach to managing the young patients who come to our clinic. Our providers include clinicians specializing in pediatric cardiology and heart disease prevention, endocrinology, gastroenterology and primary care—as well as dieticians experienced in pediatric hyperlipidemia and hypertension.
Healthy Hearts Start with a Healthy Lifestyle
With proper guidance, regular physical activity often lowers blood pressure, burns fat, lowers LDL cholesterol and lowers triglycerides. A common misconception among parents of children with hypertension is that exercise should be restricted. Initially, if blood pressure is extremely high, exercise may need to be put on hold; but ultimately, exercise reduces the risk of heart disease and some cancers.
The Preventive Cardiology Clinic staff will provide an exercise consultation to help you and your child create an exercise schedule that involves at least 30 to 60 minutes of vigorous aerobic exercise at least five days a week. In some cases, your doctors may recommend that your child avoid lifting free weights.
Avoid cigarette smoke:
Smoking constricts blood vessels, which can elevate blood pressure. In addition, second-hand smoke has been shown to significantly reduce HDL, the good cholesterol. Smoking is the most important heart disease risk factor that we can change. The Preventive Cardiology Clinic staff is strongly against smoking in and around children.
Several studies have found that high blood pressure can be reduced by incorporating an eating plan called Dietary Approaches to Stop Hypertension ("DASH" diet). This is a heart-healthy diet rich in fruits, vegetables, low fat dairy products and reduced saturated fat and sodium intakes. Elevated cholesterol, depending on its cause or causes, often responds positively to diet changes, too. At the Preventive Cardiology Clinic, registered dietitians will counsel you on ways to incorporate an eating plan into your child’s lifestyle, and will encourage your entire family to adopt healthy eating measures.
Some healthy eating tips include:
Lower saturated fat intake: Saturated fats are unhealthy fats that come mostly from animal products and generally raise LDL-cholesterol levels. To help lower LDL to an acceptable range, your child should consume 12-15 grams of saturated fat per day. That means limiting consumption of animal products, such as red meats and pork, whole milk dairy products, cheeses and butter, the skin of poultry, coconut oil, palm oil, palm kernel oil and cocoa butter. Healthy replacement fats include olive oil, canola oil, avocado and nuts.
Zero trans-fatty acids: Trans-fatty acids are artificial fats created in the 1990s by scientists looking for a cheap alternative to butter. These include hydrogenated oils, which have no health value whatsoever. In fact, in addition to increasing LDL cholesterol, trans fats decrease HDL levels. Unfortunately, trans fats are found in many packaged snacks, such as crackers and cookies, as well as in the oils used to cook deep-fried restaurant foods. Food manufacturers are required to list trans fats on food labels, but you should double-check ingredients and avoid foods that contain anything “hydrogenated” or “partially-hydrogenated.”
Lower cholesterol intake: Cholesterol intake should be reduced to less than 200 mg of cholesterol per day. The four largest dietary sources of cholesterol are liver, egg yolks, squid (calamari) and shrimp.
Increased dietary fiber: Fiber in foods refers to a part of plants that your body cannot absorb and that therefore have no caloric value. But fiber helps your body eliminate waste by bringing water to the colon and making waste softer and easier to pass. 25 to 30 grams of dietary fiber are recommended each day for adults, although children can consume less, depending on their age. Dietary fiber can be found in fruits, vegetables, whole grain foods, beans and legumes. Soluble fiber in oats can even help decrease cholesterol absorption into the blood.
Reduce added sugars and refined "white" carbohydrates: Children with elevated triglycerides are advised to decrease intake of simple sugars and refined carbohydrates such as white breads, rice and potatoes, pasta and sweet foods. One of the best ways to reduce added sugars in the diet is to reduce sugar sweetened beverages (sodas, juices, teas, lemonades).
Medication: Blood Pressure
Medication that lowers blood pressure is sometimes prescribed for children or adolescents with:
Severe hypertension that's causing organ damage
Severe hypertension that's causing symptoms. Most children with hypertension don't have symptoms; but in some severe cases, your child may experience dizziness, headaches or lightheadedness.
Hypertension secondary to another condition, such as a kidney disease
Insufficient results from diet modification and exercise
There are a number of different types of medications that lower blood pressure, and sometimes more than one is required to control high blood pressure. If medication is necessary for your child, we'll work with you to find the best solution.
Some children with severe cholesterol and triglyceride problems—particularly those who have a familial form of high cholesterol, known as familial or genetic hyperlipidemia—cannot reduce LDL cholesterol with diet management alone. If necessary, medications may be prescribed for your child if he or she has high LDL cholesterol with or without other risk factors and if lifestyle change is not sufficient.
However, we believe changes to nutrition and activity should be the first-line therapy, and medication is the last line of defense for reducing heart disease risk factors. We work with families to discuss the information available on medication and lifestyle change, and we provide as much support as possible to help you and your family come to the right decision about what makes sense for each individual child.
Screening Children for Cholesterol
The National Heart, Lung and Blood Institute, has issued important new guidelines for monitoring, and improving, cardiovascular health in children including
- screening for lipids, diabetes, obesity and high blood pressure.
- How will you respond?
Let Boston Children’s cardiologists help you navigate the changes.
- Resources for providers, summarizing the most important points
- Resources for families, including important tips on health nutrition
Learn more about some of the controversy in this NY Times article.