A Proposed Pediatric Clinical Cardiovascular Health Reference Standard

Lucia C. Petito; Megan E. McCabe; Lindsay R Pool; Amy E. Krefman; Amanda M. Perak; Bradley Scott Marino; Markus Juonala; Mika Kähönen; Terho Lehtimäki; Lydia A. Bazzano; Lei Liu; Katja Pahkala; Tomi T. Laitinen; Olli T. Raitakari; Holly C. Gooding; Stephen R. Daniels; Asheley C. Skinner; Philip Greenland; Matthew Mason Davis; Lauren S. Wakschlag; Linda V Van Horn; Lifang Hou; Donald M. Lloyd-Jones; Darwin R. Labarthe; Norrina Bai Allen

doi:10.1016/j.amepre.2023.09.019

A Proposed Pediatric Clinical Cardiovascular Health Reference Standard

Lucia C. Petito^*, Megan E. McCabe, Lindsay R Pool, Amy E. Krefman, Amanda M. Perak, Bradley Scott Marino, Markus Juonala, Mika Kähönen, Terho Lehtimäki, Lydia A. Bazzano, Lei Liu, Katja Pahkala, Tomi T. Laitinen, Olli T. Raitakari, Holly C. Gooding, Stephen R. Daniels, Asheley C. Skinner, Philip Greenland, Matthew Mason Davis, Lauren S. WakschlagLinda V Van Horn, Lifang Hou, Donald M. Lloyd-Jones, Darwin R. Labarthe, Norrina Bai Allen

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

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.

Original language	English (US)
Pages (from-to)	216-225
Number of pages	10
Journal	American Journal of Preventive Medicine
Volume	66
Issue number	2
DOIs	https://doi.org/10.1016/j.amepre.2023.09.019
State	Published - Feb 2024

Funding

This work was supported by the American Heart Association (AHA) through the Strategically Funded Prevention Research Network Center Grant to Northwestern (AHA Award Number 14SFRN20780002), the SFRN Strategic Renewal Award to Northwestern (AHA Award Number 18SRG34360001 ), and the Children's Research Network Center Grant to Lurie Children's Hospital (AHA Award Number 17SFRN33700101 ). The Young Finns Study has been financially supported by the Academy of Finland (Grants 322098 , 286284 , and 134309 [Eye]; 126925 , 121584 , 124282 , and 129378 [Salve]; 117787 [Gendi]; and 41071 [Skidi]); the Social Insurance Institution of Finland ; Competitive State Research Financing of the Expert Responsibility area of Kuopio, Tampere and Turku University Hospitals (Grant X51001 ); Juho Vainio Foundation ; Paavo Nurmi Foundation ; Finnish Foundation for Cardiovascular Research ; Finnish Cultural Foundation ; Tampere Tuberculosis Foundation ; Emil Aaltonen Foundation ; Yrjö Jahnsson Foundation ; Signe and Ane Gyllenberg Foundation ; Diabetes Research Foundation of Finnish Diabetes Association ; and EU Horizon 2020 (Grant 755320 for TAXINOMISIS and Grant 848146 for TO_AITION). The Bogalusa Heart Study was supported by Grants R01HL121230 from the National Heart, Lung, and Blood Institute ; ES021724 from the National Institute of Environmental Health Sciences ; R01AG016592 from the National Institute on Aging ; and P20GM109036 from the National Institute of General Medical Sciences of the National Institutes of Health . The Coronary Artery Risk Development in Young Adults Study is conducted and supported by the National Heart, Lung, and Blood Institute in collaboration with the University of Alabama at Birmingham ( HHSN268201800005I and HHSN268201800007I ), Northwestern University ( HHSN268201800003I ), University of Minnesota ( HHSN268201800006I ), and Kaiser Foundation Research Institute ( HHSN268201800004I ). This manuscript has been reviewed by Coronary Artery Risk Development in Young Adults Study for scientific content. Special Turku Coronary Risk Factor Intervention Project has been supported by the Academy of Finland ( 206374 , 294834 , 251360 , 275595 ); Juho Vainio Foundation ; Finnish Cultural Foundation ; Finnish Foundation for Cardiovascular Research ; Sigrid Jusélius Foundation ; Yrjö Jahnsson Foundation ; Finnish Diabetes Research Foundation ; Novo Nordisk Foundation ; Finnish Ministry of Education and Culture ; Special Governmental Grants for Health Sciences Research, Turku University Hospital ; and University of Turku Foundation . Project HeartBeat! Has been supported by the following research awards from NIH and the Centers for Disease Control and Prevention : UO1 HL41166 ; 1 RO3 HL57101 ; 1 RO3 HL59223 (cardiac development); and Centers for Disease Control and Prevention contract PO 0009966385 , Intergovernmental Personnel Agreement 00IPA24501 , and Cooperative Agreement U48/CCU609653 . Additional support from the Compaq Computer Corporation and the University of Texas Health Science Center at Houston , School of Public Health, is also gratefully acknowledged. Katja Pahkala is funded by an Academy of Finland research fellowship (Number 322112 ).

ASJC Scopus subject areas

Epidemiology
Public Health, Environmental and Occupational Health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.amepre.2023.09.019

Cite this

Petito, L. C., McCabe, M. E., Pool, L. R., Krefman, A. E., Perak, A. M., Marino, B. S., Juonala, M., Kähönen, M., Lehtimäki, T., Bazzano, L. A., Liu, L., Pahkala, K., Laitinen, T. T., Raitakari, O. T., Gooding, H. C., Daniels, S. R., Skinner, A. C., Greenland, P., Davis, M. M., ... Allen, N. B. (2024). A Proposed Pediatric Clinical Cardiovascular Health Reference Standard. American Journal of Preventive Medicine, 66(2), 216-225. https://doi.org/10.1016/j.amepre.2023.09.019

@article{f0d7d51fe9934edb9b53b3a8a2aefe52,

title = "A Proposed Pediatric Clinical Cardiovascular Health Reference Standard",

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.",

author = "Petito, {Lucia C.} and McCabe, {Megan E.} and Pool, {Lindsay R} and Krefman, {Amy E.} and Perak, {Amanda M.} and Marino, {Bradley Scott} and Markus Juonala and Mika K{\"a}h{\"o}nen and Terho Lehtim{\"a}ki and Bazzano, {Lydia A.} and Lei Liu and Katja Pahkala and Laitinen, {Tomi T.} and Raitakari, {Olli T.} and Gooding, {Holly C.} and Daniels, {Stephen R.} and Skinner, {Asheley C.} and Philip Greenland and Davis, {Matthew Mason} and Wakschlag, {Lauren S.} and {Van Horn}, {Linda V} and Lifang Hou and Lloyd-Jones, {Donald M.} and Labarthe, {Darwin R.} and Allen, {Norrina Bai}",

note = "Publisher Copyright: {\textcopyright} 2023",

year = "2024",

month = feb,

doi = "10.1016/j.amepre.2023.09.019",

language = "English (US)",

volume = "66",

pages = "216--225",

journal = "American Journal of Preventive Medicine",

issn = "0749-3797",

publisher = "Elsevier Inc.",

number = "2",

}

Petito, LC, McCabe, ME, Pool, LR, Krefman, AE, Perak, AM, Marino, BS, Juonala, M, Kähönen, M, Lehtimäki, T, Bazzano, LA, Liu, L, Pahkala, K, Laitinen, TT, Raitakari, OT, Gooding, HC, Daniels, SR, Skinner, AC, Greenland, P, Davis, MM, Wakschlag, LS , Van Horn, LV, Hou, L, Lloyd-Jones, DM , Labarthe, DR & Allen, NB 2024, 'A Proposed Pediatric Clinical Cardiovascular Health Reference Standard', American Journal of Preventive Medicine, vol. 66, no. 2, pp. 216-225. https://doi.org/10.1016/j.amepre.2023.09.019

TY - JOUR

T1 - A Proposed Pediatric Clinical Cardiovascular Health Reference Standard

AU - Petito, Lucia C.

AU - McCabe, Megan E.

AU - Pool, Lindsay R

AU - Krefman, Amy E.

AU - Perak, Amanda M.

AU - Marino, Bradley Scott

AU - Juonala, Markus

AU - Kähönen, Mika

AU - Lehtimäki, Terho

AU - Bazzano, Lydia A.

AU - Liu, Lei

AU - Pahkala, Katja

AU - Laitinen, Tomi T.

AU - Raitakari, Olli T.

AU - Gooding, Holly C.

AU - Daniels, Stephen R.

AU - Skinner, Asheley C.

AU - Greenland, Philip

AU - Davis, Matthew Mason

AU - Wakschlag, Lauren S.

AU - Van Horn, Linda V

AU - Hou, Lifang

AU - Lloyd-Jones, Donald M.

AU - Labarthe, Darwin R.

AU - Allen, Norrina Bai

PY - 2024/2

Y1 - 2024/2

N2 - 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.

AB - 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.

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U2 - 10.1016/j.amepre.2023.09.019

DO - 10.1016/j.amepre.2023.09.019

M3 - Article

C2 - 37751803

AN - SCOPUS:85176418776

SN - 0749-3797

VL - 66

SP - 216

EP - 225

JO - American Journal of Preventive Medicine

JF - American Journal of Preventive Medicine

IS - 2

ER -

A Proposed Pediatric Clinical Cardiovascular Health Reference Standard

Abstract

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ASJC Scopus subject areas

UN SDGs

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