A Proposed Pediatric Clinical Cardiovascular Health Reference Standard

Petito LC 1 , McCabe ME 2 , Pool LR 3 , Krefman AE 3 , Perak AM 4 , Marino BS 5 Show all authors , Juonala M 6 , Kähönen M 7 , Lehtimäki T 8 , Bazzano LA 9 , Liu L 10 , Pahkala K 11 , Laitinen TT 12 , Raitakari OT 13 , Gooding HC 14 , Daniels SR 15 , Skinner AC 16 , Greenland P 3 , Davis MM 5 , Wakschlag LS 17 , Van Horn L 3 , Hou L 3 , Lloyd-Jones DM 4 , Labarthe DR 3 , Allen NB 4

Affiliations 

  • 1 Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois. Electronic address: lucia.petito@northwestern.edu
  • 2 Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa
  • 3 Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois
  • 4 Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; Department of Pediatrics, Lurie Children's Hospital, Chicago, Illinois
  • 5 Department of Pediatrics, Lurie Children's Hospital, Chicago, Illinois
  • 6 Department of Medicine, University of Turku, Turku, Finland; Division of Medicine, Turku University Hospital, Turku, Finland
  • 7 Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland; Finnish Cardiovascular Research Center-Tampere - FCRCT, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
  • 8 Finnish Cardiovascular Research Center-Tampere - FCRCT, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Clinical Chemistry, Fimlab Laboratories, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
  • 9 Department of Epidemiology, School of Public Health & Tropical Medicine, Tulane University, New Orleans, Los Angeles
  • 10 Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri
  • 11 Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Paavo Nurmi Centre, Sports & Exercise Medicine Unit, Department of Health and Physical Activity, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
  • 12 Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Paavo Nurmi Centre, Sports & Exercise Medicine Unit, Department of Health and Physical Activity, University of Turku, Turku, Finland
  • 13 Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland; Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
  • 14 Division of General Pediatrics and Adolescent Medicine, Emory University School of Medicine, Atlanta, Georgia
  • 15 Department of Pediatrics, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado
  • 16 Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
  • 17 Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, Illinois
Am J Prev Med, 2024 Feb;66(2):216-225.
PMID: 37751803 DOI: 10.1016/j.amepre.2023.09.019

Abstract

INTRODUCTION: Clinical cardiovascular health is a construct that includes 4 health factors-systolic and diastolic blood pressure, fasting glucose, total cholesterol, and body mass index-which together provide an evidence-based, more holistic view of cardiovascular health risk in adults than each component separately. Currently, no pediatric version of this construct exists. This study sought to develop sex-specific charts of clinical cardiovascular health for age to describe current patterns of clinical cardiovascular health throughout childhood.

METHODS: Data were used from children and adolescents aged 8-19 years in six pooled childhood cohorts (19,261 participants, collected between 1972 and 2010) to create reference standards for fasting glucose and total cholesterol. Using the models for glucose and cholesterol as well as previously published reference standards for body mass index and blood pressure, clinical cardiovascular health charts were developed. All models were estimated using sex-specific random-effects linear regression, and modeling was performed during 2020-2022.

RESULTS: Models were created to generate charts with smoothed means, percentiles, and standard deviations of clinical cardiovascular health for each year of childhood. For example, a 10-year-old girl with a body mass index of 16 kg/m2 (30th percentile), blood pressure of 100/60 mm Hg (46th/50th), glucose of 80 mg/dL (31st), and total cholesterol of 160 mg/dL (46th) (lower implies better) would have a clinical cardiovascular health percentile of 62 (higher implies better).

CONCLUSIONS: Clinical cardiovascular health charts based on pediatric data offer a standardized approach to express clinical cardiovascular health as an age- and sex-standardized percentile for clinicians to assess cardiovascular health in childhood to consider preventive approaches at early ages and proactively optimize lifetime trajectories of cardiovascular health.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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