Aim: To evaluate whether a multidisciplinary educational program (EP) in cardiovascular prevention (CVP) for children could improve the Framingham cardiovascular risk (FCR) of their parents after one year.
Methods and results: This was a prospective community-based study in Brazil during 2010 that randomized students aged 6 to 10 years old to two different approaches to receiving healthy lifestyle information. The control group received written educational material (EM) for their parents about healthy lifestyle. The intervention group received the same EM for parents, and children were exposed to a weekly EP in CVP with a multidisciplinary health team. At onset and end of the study, we collected data from parents and children (weight, height, arterial blood pressure, and laboratory tests). We studied 197 children and 323 parents. Analyzing the parents’ FCR we found that 9.3% of the control group and 6.8% of the intervention group had more than a 10% year risk of cardiovascular heart disease (CHD) over the next 10 years. After the children’s EP for the year, the intervention group had a reduction of 91% in the intermediate/high FCR group compared with a 13% reduction in the control group, p = 0.002). In the same way, analyzing the FCR of all parents, there was a reduction of the average risk in the intervention group (3.6% to 2.8% respectively, p < 0.001) compared with the control group (4.4% to 4.4%, p = 0.98).
Conclusion: An educational program in cardiovascular prevention directed at school-age children can reduce the FCR risk of their parents, especially in the intermediate/high risk categories.
FinucaneMMStevensGACowanMJ. on behalf of the Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Body Mass Index). National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9·1 million participants. Lancet2011; 377: 557–567.
2.
FarzadfarFFinucaneMMDanaeiG. on behalf of the Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group(Cholesterol). National, regional, and global trends in serum total cholesterol since 1980: systematic analysis of health examination surveys and epidemiological studies with 321 country-years and 3·0 million participants. Lancet2011; 377: 578–586.
3.
DanaeiGFinucaneMMLinJK. on behalf of the Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Blood Pressure). National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5·4 million participants. Lancet2011; 377: 568–577.
4.
BerensonGSSrinivasanSRBaoW. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults: the Bogalusa Heart Study. N Engl J Med1998; 338: 1650–1656.
5.
BarkerDJHansonMA. Altered regional blood flow in the fetus: the origins of cardiovascular disease?Acta Paediatr2004; 93: 1559–1560.
6.
BarkerDJ. In utero programming of cardiovascular disease. Theriogenology2000; 53: 555–574.
7.
HigginsM. Epidemiology and prevention of coronary heart disease in families. Am J Med2000; 108: 387–395.
8.
SchwandtPBischoff-FerrariHAStaehelinHB. Cardiovascular risk scrrening in school children predicts risk in parents. Atherosclerosis2009; 205: 626–631.
9.
Schwandt P, Haas GM and Liepold E. Lifestyle and cardiovascular risk factors in 2001 child-parent pairs: The PEP Family Heart Study. Atherosclerosis. 2011; 219(2): 937–945.
10.
PerryCLKelderSHKomroKThe social world of adolescents: family, peers, schools, and community. In: MillsteinSGPetersonACNightengaleEO (eds). Promoting the health of adolescents: New directions for the twenty-first century, New York (NY): Oxford University Press, 1992.
11.
US Department of Health and Human Services. Health: United States, 2004. With chartbook on trends in the health of Americans, Hyattsville (MD): National Center for Health Statistics, 2004.
12.
LuepkerRVPerryCLMcKinlaySM. Outcomes of a field trial to improve children´s dietary patterns and physical activity. The Child and Adolescent Trial for Cardiovascular Health. CATCH collaborative group. JAMA1996; 275: 768–776.
13.
CarterJWiechaJPetersonKE. Planet Health, Champaign (IL): Human Kinetics Press, 2001.
14.
DinoGHornKZedoskyL. A positive response to teen smoking: Why N-O-T?NASSP Bull1998; 82: 46–58.
15.
World Health Organization. The WHO Child Growth Standards. Geneva: WHO. 2007. http://www.who.int/childgrowth/en/ (accessed 21 June 2009).
16.
The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114 (Suppl 4th Report): 555–76.
17.
Back GiulianoICaramelliBPellandaL. Guidelines for prevention of atherosclerosis in childhood and adolescence. Arq Bras Cardiol2005; 85(Suppl 6): 4–36.
18.
National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation2002; 10: 3143–31421.
19.
Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation 2004; 110: 227–39.
20.
WilsonPWFD’AgostinoRBLevyD. Prediction of coronary heart disease using risk factors categories. Circulation1998; 97: 1837–1847.
21.
ABEP. Brazil economic classification criteria. ABEP 2006 May 5. www.anep.org.br (accessed 5 May 2004).
22.
FalaschettiEHingoraniADJonesA. Adiposity and cardiovascular risk factors in a large contemporary population of pré-pubertal children. Eur Heart J2010; 31: 3063–3072.
23.
SporisevicLKrzeliVBajraktarivicA. Evaluation of cardiovascular risk in school children. Bosn J Basic Med Sci2009; 9: 182–186.
24.
GiulianoIFreitasSCoutinhoM. Distribution of HDL-cholesterol and non-HDL-cholesterol in Brazilian children and adolescents – the FLORIPA study. Nutr Metab Cardiovasc Dis2011; 21: 33–38.
25.
JuonalaMViikariJASKahonenM. Life-time risk factors and progression of carotid atherosclerosis in young adults: the Cardiovascular Risk in Young Finns study. Eur Heart J2010; 31: 1745–1751.
26.
MaisSCharakidaMWangG. Hope for the future: early recognition of increased cardiovascular risk in children and how to deal with it. Eur J Cardiovasc Prev Rehabil2009; 16(Suppl 2): S61–S64.
27.
KandaAKamiyamaYKawagushiT. Association of reduction in parental overweight with reduction in children’s overweight with a 3-year follow-up. Prev Med (Baltim)2004; 39: 369–372.
28.
GolanMWeizmanAFainaruM. Impact of treatment for childhood obesity on parent’ risk factors for cardiovascular disease. Prev Med (Baltim)1999; 29: 519–526.
