Preventive pediatric cardiology. Tobacco, cholesterol, obesity, and physical activity.

The prevention of coronary artery disease in adults begins in childhood. Public health strategies to lower the use of tobacco, improve nutrition, and increase physical activity are important for all children to lower the cardiovascular risk of the population. Physicians can contribute to public health strategies through office-based health counseling and as advocates for public health strategies both at local and higher levels. Children at high risk for cardiovascular disease can be identified through medical history (i.e., positive family history of coronary disease, history of tobacco use, and physical activity history), routine measurements (i.e., height, weight, and blood pressure), and selective laboratory screening (i.e., lipoprotein measurement). Children at high risk should receive special counseling on diet; physical activity; smoking cessation; and, if indicated, pharmacologic therapy.