CVD Children and Youth

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T es of heart disease observed in children and adolescents

Cardiovascular disease

in children and outh

Congenital heart disease

Congenital heart disease (CHD) is the type of heart disease that a baby is born with. In reality, it is adefect, or abnormality of the heart or blood vessels near the heart, and not a disease, so many peopleuse the term “congenital heart defect”. The majority of children born today with CHD will survive and withproper treatment be able to lead a normal or near-normal life. Some kinds of CHD are mild and may notbe diagnosed in infancy. Other types of CHD are severe and will be diagnosed soon after birth. Some willalso be diagnosed in prenatal screening. Examples of CHDs are:

Atrial septal defect (a hole between the upper 2 chambers of the heart).

Ventricular septal defect (a hole between the lower 2 chambers of the heart). Coarctation of the aorta (the main artery leaving the heart [aorta] is constricted). Transposition of the great arteries (the 2 large arteries leaving the right and left sides of the heart

are switched). Tetralogy of Fallot (a complex condition involving several structural defects).

Acquired heart disease

This type of heart disease is not present at birth. Two major types of acquired heart disease in childrenare rheumatic heart disease and Kawasaki disease.

Rheumatic heart disease Rheumatic heart disease is the most common acquired heart disease in many countries of the

world, especially in developing countries.

It is a condition where the heart muscle and heart valves are damaged due to rheumatic fever.

Rheumatic fever is caused by streptococcal bacteria, and usually begins as a consequence of

strep throat in children that were undiagnosed or were not treated or undertreated.

The global burden of disease caused by rheumatic fever and RHD currently falls disproportionately

on children and young adults living in low-income countries and is responsible for about 233,000

deaths annually.

At least 15.6 million people are estimated to be currently affected by RHD with a significant

number of them requiring repeated hospitalization and, often unaffordable, heart surgery in the

next five to 20 years.

The worst affected areas are sub-Saharan Africa, south-central Asia, the Pacific and indigenous

populations of Australia and New Zealand.

Up to 1 per cent of all schoolchildren in Africa, Asia, the Eastern Mediterranean region, and Latin

America show signs of the disease.

Primary prevention of acute rheumatic fever (the prevention of initial attack) is achieved by

treatment of acute throat infections caused by group A streptococcus. This is achieved by up to 10

days of an oral antibiotic (usually penicillin) or a single intramuscular penicillin injection.

© World Heart Federation, 2012



Cardiovascular disease in children and youth

Acquired heart disease, cont’d.

Rheumatic heart disease

People who have had a previous attack of rheumatic fever are at high risk for a recurrent attack,

which worsens the damage to the heart. Prevention of recurrent attacks of acute rheumatic fever is

known as secondary prevention. This involves regular administration of antibiotics, and has to be

continued for many years. Secondary prevention programmes are currently thought to be more

cost-effective for prevention of RHD than primary prevention and may be the only feasible option

for low- to middle-income countries in addition to poverty alleviation efforts.

Surgery is often required to repair or replace heart valves in patients with severely damaged

valves, the cost of which is very high and a drain on the limited health resources of poor countries.

Kawasaki disease

Kawasaki disease is characterized by fever, rash, swollen hands and feet, bloodshot eyes, swollen

lymph nodes, a strawberry appearance to the tongue, and an acute inflammation of the blood

vessels, especially the coronary arteries.

Its cause is unknown but may be some kind of infectious agent.

Occurs in young children – 80% or more are less than 5 years old, and occurs more in boys than in

girls.

Kawasaki disease is most common in Japan, but has been seen in virtually every country in theworld and is the leading cause of acquired heart disease among children in developed countries.

In some children, especially those who are undiagnosed or untreated or not treated soon enough,

serious heart damage can occur.

Other heart disease types

Other heart disease types that have been observed in children, but that are also seen in adults, includeChagas disease – a parasite borne infection that primarily affects rural populations in low-income

countries – cardiomyopathy and infectious endocarditis. Children can also develop abnormal heartrhythms, especially those with certain kinds of CHD.

Childhood overweight/obesity can lead to heart disease risk in later life

Risk factors for CVD are determined to a great extent by behaviours learned in childhood and continuedinto adulthood – such as dietary habits.

Childhood and adolescent overweight is one of the most important current public health

concerns.

The problem is global and is steadily affecting many low- and middle-income countries, particularly

in urban settings.

Overweight and obese children and adolescents are likely to develop a number of precursors for

CVD, such as type-2 diabetes, hypertension, dyslipidemia and the metabolic syndrome.




Childhood overweight/obesity can lead to heart disease risk in later life

Cardiovascular disease in children and youth

There is strong evidence that an epidemic of childhood obesity has led to a significant increase in

the prevalence of cardiovascular risk factors, which, if left unchecked, is likely to lead to an

epidemic of premature CVD1.

The burden of childhood obesity

Worldwide, one in 10 school-aged children are estimated to be overweight1.

Globally, in 2010 the number of overweight children under the age of five is estimated to be over

42 million. Close to 35 million of these are living in developing countries3.

Childhood obesity is already an epidemic in some areas and on the rise in others. For example, in

the USA, the number of overweight children has doubled and the number of overweight

adolescents has trebled since 19804.

Environmental factors contributing to childhood obesity

Societal changes associated with economic growth, modernization, globalization, as well as changes innutrition habits across the world, are driving the obesity epidemic.

Many factors are fuelling the obesity epidemic in children, such as increased consumption of

energy-dense, high-calorie foods and drinks, and decreased physical activity5.

Schools have a very important role in preventing obesity by providing more nutritious food, offering

greater opportunities for physical activity, and providing obesity-related health services6

.

Some countries, such as the UK, are taking action to ban advertising of high fat, salt and sugar

products during or around programmes made for children, or that are likely to appeal to children,

due to the link between food advertising and childhood obesity1.

1McCrindle BW, ‘Cardiovascular consequences of paediatric obesity: Will there be a future epidemic of premature

cardiovascular disease?’ Paediatr Child Health. 2007 March; 12(3): 175–177. 2Lobstein T., Baur L., Uauy R. IASO International Obesity TaskForce. Obesity in children and young people: a crisisin public health. Obesity Reviews 2004;5(s1): pp 4–85.

3Anderson PM, Butcher KE. Childhood obesity: trends and potential causes. Future Child . 2006;16(1):19–45.

4World Health Organization. Global Strategy on Diet, Physical Activity and Health – Obesity and Overweight. Lastaccessed at http://www.who.int/dietphysicalactivity/publications/facts/obesity/en/, 3 December 2010.

5Ofcom Television Advertising of Food and Drink Programmes to Children, 22 Feb 2007, last accessed at:http://stakeholders.ofcom.org.uk/consultations/foodads_new/statement/, 3 December 2010.

6 Story M, Kaphingst KM, French S. The role of schools in obesity prevention. Future Child. 2006 Spring;

16(1):109–142.

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