Management of cardiovascular disease risk factors in children. A national survey of primary care physicians.

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.