A Proposed Pediatric Clinical Cardiovascular Health Reference Standard

Lucia C. Petito, Megan E. McCabe, Lindsay R. Pool, Amy E. Krefman, Amanda M. Perak, Bradley S. Marino, Markus Juonala, Mika Kähönen, Terho Lehtimäki, Lydia A. Bazzano, Lei Liu, Katja Pahkala, Tomi T. Laitinen, Olli T. Raitakari, Holly C. Gooding, Stephen R. Daniels, Asheley C. Skinner, Philip Greenland, Matthew M. Davis, Lauren S. WakschlagLinda Van Horn, Lifang Hou, Donald M. Lloyd-Jones, Darwin R. Labarthe, Norrina B. Allen

Research output: Contribution to journalArticleScientificpeer-review


Introduction: Clinical cardiovascular health is a construct that includes 4 health factors—systolic and diastolic blood pressure, fasting glucose, total cholesterol, and body mass index—which together provide an evidence-based, more holistic view of cardiovascular health risk in adults than each component separately. Currently, no pediatric version of this construct exists. This study sought to develop sex-specific charts of clinical cardiovascular health for age to describe current patterns of clinical cardiovascular health throughout childhood. Methods: Data were used from children and adolescents aged 8–19 years in six pooled childhood cohorts (19,261 participants, collected between 1972 and 2010) to create reference standards for fasting glucose and total cholesterol. Using the models for glucose and cholesterol as well as previously published reference standards for body mass index and blood pressure, clinical cardiovascular health charts were developed. All models were estimated using sex-specific random-effects linear regression, and modeling was performed during 2020–2022. Results: Models were created to generate charts with smoothed means, percentiles, and standard deviations of clinical cardiovascular health for each year of childhood. For example, a 10-year-old girl with a body mass index of 16 kg/m2 (30th percentile), blood pressure of 100/60 mm Hg (46th/50th), glucose of 80 mg/dL (31st), and total cholesterol of 160 mg/dL (46th) (lower implies better) would have a clinical cardiovascular health percentile of 62 (higher implies better). Conclusions: Clinical cardiovascular health charts based on pediatric data offer a standardized approach to express clinical cardiovascular health as an age- and sex-standardized percentile for clinicians to assess cardiovascular health in childhood to consider preventive approaches at early ages and proactively optimize lifetime trajectories of cardiovascular health.

Original languageEnglish
JournalAmerican Journal of Preventive Medicine
Publication statusE-pub ahead of print - 24 Sept 2023
Publication typeA1 Journal article-refereed

Publication forum classification

  • Publication forum level 2

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health
  • Physiology (medical)
  • Pediatrics, Perinatology, and Child Health


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