Reducing Cardiovascular Disease Risk in Youth

Recently published guidelines for cardiovascular health and risk reduction in children and adolescents evaluated the evidence regarding all major cardiovascular disease (CVD) risk factors and recommended an extensive array of age-based assessments and interventions.

Diet and Nutrition

  • Limit total fat to ≤30% of daily calorie intake, and saturated fat to 8-10%
  • Cholesterol intake should be <300 mg per day
  • Daily 400IU vitamin D supplementation for all infants and children; no other vitamin, mineral, or dietary supplements recommended

Physical Activity

  • At least 1 hour moderate-to-vigorous activity each day for children ≥6 years; vigorous activity 3 days/week
  • Limit leisure screen time to <2 hours/day

Tobacco Exposure

  • Routinely identify through medical history pediatric patients who smoke
  • Explicitly inform patients about the addictive and adverse health effects of tobacco use
  • Identify parents who smoke and counsel that children should not be exposed to secondhand smoke


  • Annual blood pressure measurement starting at age 3
  • Age-specific algorithm and blood pressure cutoffs to detect and diagnosis prehypertension and hypertension

Overweight and Obesity

  • Identify children starting at age 2 who are high risk for obesity because of parental obesity and excessive body mass index (BMI) increase
  • Age-specific algorithm based on BMI percentile for assessments and interventions

Diabetes and Other Conditions that Predispose for Accelerated Atherosclerosis

  • Follow American Diabetes Association screening algorithm for type 2 diabetes in childhood
  • Identify risk and management based on specified high- and moderate-risk conditions

Risk Factor Clustering and the Metabolic Syndrome

  • Intensify therapy with an emphasis on lifestyle modification when a child has any combination of multiple risk factors
  • Obesity alone should prompt evaluation for all other CVD risk factors
  • When obesity exists along with any other major CVD risk factors, start intensive weight reduction efforts and manage risk factors, including starting drug therapy
  • Evaluate the child promptly for diabetes, liver function abnormalities, left ventricular hypertrophy, and sleep apnea

Perinatal Factors

  • Counsel mothers accompanying children to pediatric visits to either remain smoke-free or to quit smoking