When to refer a pediatric patient to preventive cardiology

Children with a high cholesterol panel or three consecutive elevated blood pressure readings should be referred to a cardiologist for preventive cardiology, and there is a list of additional criteria that primary care providers can consult before making a referral.

“A child can have one or multiple risk factors, and we can intervene before the patient develops heart disease,” said Jyothi M. Matta, M.D., pediatric cardiologist with Norton Children’s Heart Institute, affiliated with the UofL School of Medicine.

Dr. Matta and other specialist physicians see patients in the Norton Children’s Metabolic Syndrome Clinic, a multidisciplinary clinic that aims to prevent acquired heart disease in children. The clinic offers comprehensive care for children with obesity, dyslipidemia and hypertension, with cardiologists, nephrologists, endocrinologists and a general pediatrician dedicated to identifying and addressing cardiovascular risk factors in children.

Related: Don’t overlook child blood pressure readings

Criteria for referral to preventive cardiology

To be referred to the multidisciplinary clinic, patients must be under age 18 and meet the following guidelines.

 Any ONE of these criteria:

• Low-density lipoprotein (LDL) higher than 130 mg/dL
• Triglycerides higher than 250 mg/dL, regardless of body mass index (BMI)
• Hypertension (blood pressure above the 95th percentile for age or currently being treated for hypertension)
• BMI greater than 35
• A family history of stroke or heart attack (under age 55 for women or under 65 for men)

OR  

At least TWO cardiac or metabolic risk factors, including:

• BMI greater than 30
• Glucose intolerance or insulin resistance
• High-density lipoprotein (HDL) lower than 40 mg/dL
• Low-density lipoprotein (LDL) higher than 110 mg/dL
• Total cholesterol greater than 170 mg/dL
• Triglycerides higher than 150 mg/dL
• A disease state that increases risk for the development of early atherosclerosis, including Kawasaki disease with a history of aneurysm, solid organ transplant, nephrotic syndrome, diabetes or an autoimmune disorder (such as lupus)

The Centers for Disease Control and Prevention recommends that children should have their cholesterol checked at least once between ages 9 and 11 and again between ages 17 and 21.