**8. Diagnostic work-up of cardiovascular risk factors in children**

Cardiovascular complications, such as myocardial infarction and stroke, are rare in children, however, cardiovascular risk factors are increasing in prevalence, mostly due to worldwide increment of obesity. Preventive measures are most important in children and young adults, where the atherosclerotic process can be slowed down and possibly clinical manifestations of cardiovascular disease delayed [45].

Preventive measures can be individualized or population-based. The individualized approach includes active search of at-risk children during health check, who are more likely to develop premature CVD due to an underlying disease, inappropriate lifestyle or genetic disposition. Population-based approach includes interventions that affect the entire population aiming to lower cardiovascular risk in the whole population [45].

In pediatrics, we are most commonly involved in an individualized approach. Established recommendations in cardiovascular risk management in children involve two different goals: the prevention of risk-factor development and prevention of future CVD by effective management of identified risk factors. Therefore, several risk factors should be evaluated for, namely family history, diet, physical inactivity, tobacco exposure, blood pressure, lipid levels, overweight or obesity, diabetes mellitus, metabolic syndrome and perinatal factors [45].

*Cardiovascular Risk Factors in Children DOI: http://dx.doi.org/10.5772/intechopen.99729*


**Table 4.**

*Common investigations in children with cardiovascular risk; TSH—thyroid stimulating hormone, HbA1c—glycosylated hemoglobin, ECG—electrocardiogram.*

The management of children with cardiovascular risk factors should be tailored to identify other possible cardiovascular risks, to evaluate end organ damage and to advise proper therapy. It starts with a good history with focus on family history and lifestyle. Next, clinical examination with anthropometric measurements with respect to percentile curves and blood pressure measurement should be performed. If blood pressure is elevated on multiple occasions, an ambulatory blood pressure measurement is recommended. Further work-up depends on history and examination and involves several laboratory, imaging and functional diagnostics, presented in **Table 4**.

In addition to above diagnostics, selected novel cardiovascular factors can be determined. Quite a few new diagnostic options to better define cardiovascular risk are on horizon, investigated in prospective studies, shortly presented in the next section.
