Abstract P100: Improving Ideal Cardiovascular Health in a Pediatric Preventive Cardiology Practice

Introduction: Achieving ideal cardiovascular health (iCVH) for children necessitates both public health and individual interventions. Hypothesis: We hypothesized that children referred to a multidisciplinary preventive cardiology clinic would demonstrate improved iCVH after clinic-based lifestyle counseling. Methods: We analyzed data from youth ages 8-19 years seen for ≥2 consecutive visits in the Boston Children’s Hospital Preventive Cardiology clinic between 2010-2017. Demographic information, smoking status, diet, and physical activity were self-reported. Anthropometric data, blood pressure, fasting cholesterol, and fasting glucose were measured using standard protocols. We applied AHA definitions of ideal, intermediate, and poor iCVH with minor adaptations to data extracted from a clinical registry. Each iCVH metric had a possible range of 0 (poor) to 2 (ideal); the total iCVH score could range from 0 (all poor) to 14 (all ideal). Results: Median age of the 767 children in the study was 12.5 years [IQR 10.2,15.9]; 414 (54%) were female and 32 (5%) had a moderate or high CVD risk condition (diabetes, renal disease, Kawasaki, congenital heart disease, or heart transplant). Over a median of 3.9 [IQR 3.2, 6.0] months from initial assessment to first follow-up, mean iCVH score improved from 7.7 (SD 2.2) to 8.1 (SD 2.2) (p < 0.001). Females had higher iCVH scores at baseline and follow-up (females 7.9 to 8.4 vs. males 7.5 to 7.9, p<0.001), as did children younger than 14 years of age (data not shown). iCVH score improved to a mean of 8.3 (SD 2.4) for the 449 children returning for a third visit. The largest improvement was observed in total cholesterol and dietary habits (Figure); only 61 (8%) of children were prescribed statin therapy. Conclusion: Multidisciplinary clinical care can improve the iCVH of children who present with non-optimal levels, largely without the use of medications. Further work is needed to determine the scalability and long-term effectiveness of cardiovascular health promotion efforts in pediatric care.