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Julia A. McMillan, MD, editor-in-chief of Contemporary Pediatrics, is professor of pediatrics, vice chair for pediatric education, and director of the residency training program, Johns Hopkins University School of Medicine, Baltimore.
The American Academy of Pediatrics Web site states that the AAP is "an organization of 60,000 pediatricians committed to the optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults."
This month's issue of Contemporary Pediatrics includes an article, "An Emerging Dyslipidemia: Assessing Future Cardiovascular Risk in Children," that reminds pediatricians that our responsibilities actually extend to prevention of conditions that impair the health and shorten the lifespan of adults.
Written by Samuel S. Gidding, MD, this article reviews the evidence demonstrating that risk factors for adult cardiac disease can be identified and treated during childhood.
These efforts were successful enough that about 35 years ago, "new morbidities" captured the attention of pediatrics when it became clear that as a result of improved medical care, prevention efforts, and public health advocacy, psychosocial, behavioral, and developmental concerns had equaled or surpassed physical illness and injury as determinants of well-being. The concerns identified as the new morbidity have certainly not been eliminated, but genetic research, long-term studies, and improved care of children with chronic conditions now enable pediatric care to ameliorate some adult health problems.
When efforts to prevent adult morbidity involve pharmaceutical treatment of apparently asymptomatic children, however, pediatricians appropriately want to be convinced of both the efficacy and the safety of the intervention. For that reason, recommendations to screen all children for dyslipidemia and to intervene with dietary changes and/or medications when the results suggest risk for later cardiovascular disease have been met with skepticism.
As Gidding outlines, there is now robust evidence that links genes, environment, and diet in childhood to cardiovascular outcomes in adulthood. The potential that intervention through lifestyle, diet, and, in some cases, medication, may interrupt that link was convincing enough to an expert panel that formal recommendations have now been published.1 With these guidelines, pediatricians are expected to accept responsibility for improving the health of their patients, not until they are 22, but for several decades after that. Next month, Gidding will provide us with an overview of these new lipid management guidelines.
Is implementation of these guidelines even possible on a large scale? Will implementation of the recommendations of the expert panel really result in longer lives and less morbidity for our current patients? The answers to these questions cannot be known today, but the challenge to identify subclinical conditions in children that will affect their health as adults is one that we will be increasingly asked to accept. It is an opportunity we should embrace.
1. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents; National Heart, Lung and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics. 2011;128(suppl 5):S213-S256.