CVD Prevention in Children and Implications for the School Nurse

Cardiovascular Disease Risk Factors in Children

Cardiovascular disease (CVD) is the number one cause of death among adults in the United States. CVD accounted for more than 900,000 deaths in 2020.1 Risk factors for CVD are hypertension, diabetes, hyperlipidemia, physical inactivity, overweight/obesity, tobacco use, unhealthy eating, and unhealthy sleep.2 However, according to outcomes of the Coronary Artery Risk Development in Young Adults (CARDIA) study, maintaining a healthy lifestyle through young adulthood reduces the risk of developing CVD later in life.3–5

Additional evidence has further revealed the importance of initiating heart-healthy behaviors in childhood as the risk factors for CVD can begin in childhood and are likely to continue into adulthood.6,7 The measures for CVD prevention in children are similar to those in adults, such as adequate sleep, healthy eating habits, physical activity, prevention of overweight and obesity, assessment and management of hypertension, and stress reduction.8

Obesity is a major risk factor for all ages.9 In children, obesity has an important impact on CVD development during adulthood. Approximately 19% of children in the United States are affected by obesity, and previous evidence reveals the prevalence has increased significantly in children over the last three decades, making obesity a public health concern.9,10 The prevalence of obesity is highest among Hispanic children at 26.2%, followed by non-Hispanic Black children at 24.8%, non-Hispanic White children at 16.6%, and non-Hispanic Asian children at 9.0%.9 Obesity and physical inactivity are two interrelated CVD risk factors that can be addressed in the school system.

An important factor to consider is that children cannot initiate heart-healthy measures independently. The initiation of these behaviors should be completed in a collaborative manner in their homes, schools, through their healthcare providers, and other places that have a significant impact on their everyday lives.11,12 The school system is an ideal place to initiate heart-healthy behaviors in children.12 Children spend a significant amount of time in school, where they may receive breakfast and lunch13 and a snack if they participate in an after-school program. Moreover, schools are an ideal place for students to initiate heart-healthy programs by engaging in physical activity programs.12

One integral component of addressing heart health in schools is the connection with school nurses. School nurses are in a unique position to assist in the prevention of CVD in children. Nurses are academically trained to assess, implement, educate, and evaluate their interventions. This same approach is applicable to CVD prevention in the school system.14

How School Nurses Can Promote Heart-Health Among Children

  1. Identify students at risk for CVD and work collaboratively with parents and healthcare providers to coordinate the care needed for these students.15
  2. Develop and implement educational programs on CVD prevention for students and families.15
  3. Promote the collaboration of efforts among school administrators, health care providers, and parents in developing and implementing policies and programs designed to reduce obesity in children.16 They can also advocate for policies to provide heart-healthy nutrition for school-aged children.
  4. Work collaboratively with cardiovascular nurse scientists to conduct longitudinal studies to explore the impact of school-based programs designed to prevent chronic disease.17,18
  5. Provide students and families with contacts for additional community resources and services to improve the sustainability of school-based programs.

The risk factors for CVD in children are evident and on the rise. The initiation of heart-healthy behaviors in childhood can impact CVD prevention in adulthood. This initiative requires a collaborative effort among parents, healthcare providers, and the school system.


  1. Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association | Circulation. Accessed March 22, 2023.
  2. Life’s Essential 8. Accessed March 14, 2023.
  3. Liu K, Daviglus ML, Loria CM, et al. Healthy Lifestyle Through Young Adulthood and the Presence of Low Cardiovascular Disease Risk Profile in Middle Age. Circulation. 2012;125(8):996-1004. doi:10.1161/CIRCULATIONAHA.111.060681
  4. Hankinson AL, Daviglus ML, Bouchard C, et al. Maintaining a High Physical Activity Level Over 20 Years and Weight Gain. JAMA. 2010;304(23):2603-2610. doi:10.1001/jama.2010.1843
  5. Chow LS, Odegaard AO, Bosch TA, et al. Twenty year fitness trends in young adults and incidence of prediabetes and diabetes: the CARDIA study. Diabetologia. 2016;59(8):1659-1665. doi:10.1007/s00125-016-3969-5
  6. Abrignani MG, Lucà F, Favilli S, et al. Lifestyles and Cardiovascular Prevention in Childhood and Adolescence. Pediatr Cardiol. 2019;40(6):1113-1125. doi:10.1007/s00246-019-02152-w
  7. Bjerregaard LG, Adelborg K, Baker JL. Change in body mass index from childhood onwards and risk of adult cardiovascular disease,. Trends Cardiovasc Med. 2020;30(1):39-45. doi:10.1016/j.tcm.2019.01.011
  8. What parents can do to protect kids from heart disease. Accessed February 16, 2023.
  9. Bryan S, Afful J, Carroll M, et al. NHSR 158. National Health and Nutrition Examination Survey 2017–March 2020 Pre-Pandemic Data Files. National Center for Health Statistics (U.S.); 2021. doi:10.15620/cdc:106273
  10. Sanyaolu A, Okorie C, Qi X, Locke J, Rehman S. Childhood and Adolescent Obesity in the United States: A Public Health Concern. Glob Pediatr Health. 2019;6:2333794X19891305. doi:10.1177/2333794X19891305
  11. Kolbe LJ. School Health as a Strategy to Improve Both Public Health and Education. Annu Rev Public Health. 2019;40(1):443-463. doi:10.1146/annurev-publhealth-040218-043727
  12. Steinberger J, Daniels SR, Hagberg N, et al. Cardiovascular Health Promotion in Children: Challenges and Opportunities for 2020 and Beyond: A Scientific Statement From the American Heart Association. Circulation. 2016;134(12):e236-e255. doi:10.1161/CIR.0000000000000441
  13. School & Community Meals. No Kid Hungry. Accessed March 14, 2023.
  14. Northrup KL, Cottrell LA, Wittberg RA. L.I.F.E.: A School-Based Heart-Health Screening and Intervention Program. J Sch Nurs. 2008;24(1):28-35. doi:10.1177/10598405080240010501
  15. CDC. Recognizing School Nurses. Centers for Disease Control and Prevention. Published April 19, 2022. Accessed February 16, 2023.
  16. Obesity | Healthy Schools | CDC. Published August 23, 2022. Accessed February 16, 2023.
  17. Advancing the Science of School Nursing. Campaign for Action. Published December 7, 2021. Accessed February 16, 2023.
  18. Hayman LL. Prevention of Atherosclerotic Cardiovascular Disease in Childhood. Curr Cardiol Rep. 2020;22(9):86. doi:10.1007/s11886-020-01332-y

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