Heart Disease Starts in Childhood

There is growing evidence that lifestyle factors influence heart disease risk as early as adolescence and even childhood. Two new studies suggest a link between early obesity, high cholesterol, high blood pressure, and an elevated risk of cardiovascular disease later in life.

There is growing evidence that lifestyle factors influence heart disease risk as early as adolescence and even childhood. Two new studies suggest a link between early obesity, high cholesterol, high blood pressure, and an elevated risk of cardiovascular disease later in life. The findings point to the importance of promoting healthy lifestyles early, says researcher Gerald S. Berenson, MD, who has followed a group of children living in Bogalusa, La., for the past 30 years to assess their risk for heart attacks and strokes. His study and similar research from Finland are published in the Nov. 5 issue of The Journal of the American Medical Association. “These latest findings confirm what we have known for some time,” Berenson tells WebMD. “Cardiovascular damage occurs early and is strongly linked to obesity and other known risk factors. It is never too early to be concerned about these risk factors.” Childhood Cholesterol and Obesity Matter In the latest report on the Bogalusa study, Berenson and colleagues studied 486 people between the ages of 25 and 37 with at least three traditional risk factors for heart disease since childhood. Although the young adults had no outward signs of heart disease, cardiovascular risk factors measured during childhood such as obesity and “bad” LDL cholesterol were associated with increased carotid artery wall thickness. Carotid arteries on either side of the neck carry oxygen-rich blood away from the heart to the head and body. A thickening of the walls of these arteries due to fat and cholesterol deposits — known as atherosclerosis — is a marker for heart disease. The researchers also found that adult measures of obesity, higher than normal LDL cholesterol levels, and systolic blood pressure were independent risk factors for carotid artery wall thickening. The men in the study had a higher overall risk than did the women, and blacks were at higher risk than whites. Larger Study, Similar Findings The second study included 2,229 white adults between the ages of 24 and 39 who were also first examined during childhood and adolescence. Lead author Olli T. Raitakari, MD, PhD, and colleagues from the University of Turku, Finland, found that risk factors measured between the ages of 12 and 18 were linked to carotid artery wall thickness prior to age 40. These risk factors included obesity, high levels of LDL cholesterol, high systolic blood pressure, and smoking, and they remained significant after adjustment for other potential risks. These same risk factors, measured during adulthood, also predicted thickening of the carotid artery wall. “Exposure to risk factors in childhood may contribute to the development of future atherosclerosis,” Raitakari and colleagues write. “These findings suggest that the prevention of atherosclerosis … could be most effective when initiated in childhood or adolescence.” Targeting Kids and Teens In an editorial accompanying the two studies, Henry C. McGill Jr., of the Southwest Foundation for Biomedical Research, says there is little doubt that prevention programs aimed at kids and teens could have a dramatic impact on future public health. “I think it will take massive cultural changes in what we eat and how we raise our kids to really see a reversal in the obesity epidemic, and I don’t have any illusions about this happening tomorrow,” he tells WebMD. “It has taken 40 years to make a significant impact on smoking, and I think that is the kind of major public effort we are talking about.” (Source: Shengxu, L. The Journal of the American Medical Association, Nov. 4, 2003; vol 290: pp 2271-2283. Henry C. McGill, MD, senior scientist emeritus, Southwest Foundation for Biomedical Research, University of Texas Health Science Center, San Antonio. Gerald S. Berenson, MD, Tulane Center for Cardiovascular Health, New Orleans. Olli T. Raitakari, MD, PhD, department of clinical physiology and PET Center, University of Turku, Finland: WebMD Health News: November 2003)