Management of cardiovascular disease risk factors in children. A national survey of primary care physicians
S. Y. Kimm, G. H. Payne, E. Lakatos, C. Darby and A. Sparrow
Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.
A national survey of family physicians, general practitioners, and
pediatricians revealed substantial physician differences in managing
cardiovascular disease risk factors in children aged 2 to 18 years.
Pediatricians tended to screen younger children but were more conservative
in treatment. General practitioners tended to screen less and to initiate
intervention in older children, but were more aggressive in therapy. While
only 9% of surveyed physicians measured blood cholesterol levels routinely,
72% screened children with family histories of cardiovascular disease. The
majority routinely measured blood pressure, but the ages of first
measurements differed among physicians. Surprisingly, of those who had
treated children with elevated blood pressure or blood cholesterol, 54%
said that they had ever used antihypertensive and 12% used lipid-lowering
drugs in children, including angiotensin converting enzyme inhibitors and
clofibrate. Half the surveyed physicians felt prepared to provide dietary
counseling, but only 14% felt successful with it. When asked what they
considered were the major cardiovascular risk factors, less than one third
of the physicians cited all three major factors: hypertension,
hypercholesterolemia, and smoking.
