Coronary Heart Disease Prevention

Approximate population or public health

This approach involves the whole population and seeks to turn the entire population of the risk factors through lifestyle fit and healthy such as:

1. Eliminating smoking.
2. Diagnose and control hypertension.
3. Diagnosing and controlling hiperbetalipoproteinemia.
4. Diagnose and control diabetes mellitus.
5. Maintenance of ideal body weight.
6. Doing regular physical activity.
7. The addition of the input fiber grains, fruits and vegetables in their diet.
8. Reduction in dietary energy intake derived from fat, saturated fat, salt, and sucrose.

The main component of the prevention of CHD is to lower the average cholesterol level through the progressive improvement in food patterns in the population. For children aged 2 years is not recommended to reduce fat and cholesterol in foods because of ongoing rapid growth process. For children older than 2 years is recommended to follow the diet as follows:

1. Adequate nutrition should be achieved by eating a varied diet.
2. Adequate calories should be available for normal growth and development.
3. Total fat intake does not exceed 30% of the total calories of food.
4. Saturated fatty acids of less than 10% of the total calories of food
5. Put cholesterol should be less than 300 mg, per day
6. Individual approaches (high-risk children)

This approach is aimed at individuals with high risk and targeting behavior changes specific to each individual to reduce CHD. Children and adolescents with high risk are:

1. Who have a parent with a history of myocardial infarction, sudden coronary death, cerebrovascular accident before the age of 50 years in men or before age 60 years in women.
2. Families with hypertension or abnormal levels of lipids or lipoproteins are extreme (and hiperbetalipoproteinemia familial hyperlipidemia).
3. Children who are detected with high levels of CHD risk factors are high but have no family history of premature CHD. Strain test performed on children with high risk and who gets the major attention is the examination of blood cholesterol levels and blood pressure.

American Academy of Pediatrics (AAP) has recommended that in children older than 2 years, including the high risk groups be screened for cholesterol levels. Protocol screened varies based on the reason for the examination. For children who have one parent with higher cholesterol levels than at 240 mg / dl, the initial inspection is a measurement of total cholesterol levels. If total cholesterol is within normal limits 170
mg/100 ml, cholesterol measurement was repeated in 5 years. If a borderline total cholesterol levels (170-199 mg/100 ml), conducted a second inspection and averaged with the results of the first examination. If the average is borderline or high, then do fasting lipoprotein analysis. If high cholesterol levels (> 200 mg/100 ml), fasting lipoprotein analysis should be performed. For children who have a family history of premature CHD, the initial inspection should be done is a lipoprotein analysis that requires fasting 12 hours to obtain an accurate triglyceride levels, which is necessary for the calculation of LDL cholesterol levels.

LDL cholesterol levels an average of determining the steps to risk assessment and treatment:

1. LDL cholesterol levels are still within the normal range (<110 mg / dl). Provide education on the pattern of food for all children and adolescents and other risk factors. Repeat lipoprotein analysis done in 5 years.
2. LDL cholesterol levels are borderline (110-129 mg / dl). Provide advice on risk factors of CHD, were given a diet the first step (step-one diet, see table 1) and re-evaluated in 1 year.
3. High LDL cholesterol levels (> 130 mg / dl). Check for secondary causes (thyroid, liver and kidney disorders) and familial disorders, screened for all family members. Fed a diet beginning with the first step (step-one diet), followed by the diet the second step (step-two diet, see Table 1) when the diet fails to achieve the first step for at least 3 bulan.19, 20 In the extreme cases given treatment.

Drug therapy is recommended in children aged 10 years or more, if, after giving the diet therapy for 6 months - 1 year, still found:

1. LDL levels still are at or above 190 mg/100 ml, or

2. LDL levels still are at or above 160 mg / dl plus:

• There is a family history of premature CHD.
• Two or more other risk factors of CHD (such as low HDL <35 mg / dl, cigarette smoking, high blood pressure, obesity and diabetes mellitus) is encountered. The medications recommended for the treatment of hypercholesterolemia and high LDL cholesterol in the bile acid sequestrants children (cholestyramin and colestipol).