Author + information
- Stephen R. Daniels, MD, PhD∗ ()
- ↵∗Children's Hospital Colorado, 13123 East 16th Avenue, B065, Aurora, Colorado 80045
I appreciate the comments by Dr. Babu and colleagues regarding my paper (1) with respect to the importance of lifestyle factors in general and specifically the role of physical activity in the prevention of atherosclerotic cardiovascular disease (CVD). In CVD prevention, there are several elements that must be considered. The first, and in some ways the most important, is to focus on primordial prevention. This is to prevent CVD risk factors from developing in the first place. In the context of primordial prevention, lifestyle factors are most important. Unfortunately, data from the National Health and Nutrition Examination Survey indicate that we are not doing very well in maintenance of low-risk status in children and adolescents in the United States (2). A second issue is primary prevention. This is the focus on children and adolescents who have already developed risk factors, including elevated low-density lipoprotein cholesterol level, low high-density lipoprotein cholesterol level, increased blood pressure, diabetes, obesity, and cigarette smoking. In the setting of primary prevention, lifestyle factors are also quite important but may sometimes not be enough to lower risk. This is where pharmacological intervention along with lifestyle intervention may be required.
In any case, we need a broad focus on improvement of diet and physical activity for children and adolescents. Although these lifestyle interventions may be difficult to implement in clinical practice, that should not be used as an excuse to ignore their importance or to rush to pharmacological intervention.
- American College of Cardiology Foundation
- Daniels S.R.
- Shay C.M.,
- Ning H.,
- Daniels S.R.,
- Rooks C.R.,
- Gidding S.S.,
- Lloyd-Jones D.M.