Although for most children the process of atherosclerosis is subclinical, dramatically accelerated atherosclerosis occurs in some pediatric disease states, with clinical coronary events occurring in childhood and very early adult life. As with most scientific statements about children and the future risk for cardiovascular disease, there are no randomized trials documenting the effects of risk reduction on hard clinical outcomes. A growing body of literature, however, identifies the importance of premature cardiovascular disease in the course of certain pediatric diagnoses and addresses the response to risk factor reduction. For this scientific statement, a panel of experts reviewed what is known about very premature cardiovascular disease in 8 high-risk pediatric diagnoses and, from the science base, developed practical recommendations for management of cardiovascular risk.

Exercise testing of children differs from adult exercise testing in many ways beyond the technical issues related to test performance that are addressed in this report. Disease processes that produce myocardial ischemia are relatively rare in children compared with adults. Exercise testing may be useful in these cases, but the use of testing to assess functional capacity or cardiac rhythms will be encountered more often. Although the precise role of exercise testing in patient evaluation or long-term management of the cardiac patient will vary somewhat from center to center, exercise testing is often essential to diagnose and to direct treatment in a wide variety of clinical problems. An understanding of the role of exercise testing for children with known or suspected heart abnormalities is an essential part of the training of pediatric cardiologists. The staff of the pediatric exercise laboratory should be available to discuss with the clinician when a test might be of value in a specific case in addition to providing advice about the specifics of the performance of the test and offering age- and size-appropriate normal data from the laboratory with test interpretation.

Cardiovascular disease is the leading cause of death in the United States despite a steady reduction in mortality over the last 4 decades. Much of this success is attributed to public health efforts to reduce cardiovascular risk factors, such as national dietary changes and reductions of smoking, as well as more aggressive treatment of clinical disease, including recognition and treatment of hypertension and hypercholesterolemia. The rising rates of obesity and diabetes, especially among adolescents and young adults, raise concern for impending increases in mortality due to these two factors. Some national vital statistics data have shown a leveling of CVD death rates among adults in the fifth decade of life. Major public health efforts have recently begun to address childhood obesity now as an attempt at true primary prevention. This article reviews the dyslipidemia associated with obesity in childhood and outlines a proposed approach to management.

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