Risk Factors in Childhood May Predict Cardiovascular Disease in Adulthood
]]>Atherosclerosis]]> is the buildup of fatty deposits, cholesterol, calcium, and other substances—called “plaque”—in the interior walls of the arteries. This buildup causes the arteries to become hard and narrow, making them more likely to rupture or become blocked. Atherosclerosis can lead to serious health complications, including ]]>heart attack]]> , ]]>stroke]]> , and sudden death.
Most researchers believe that atherosclerosis begins with damage to the interior wall of the artery. Many factors can contribute to arterial wall damage, including:
While the effects of atherosclerosis usually don’t surface until mid-life or later, autopsy studies have now confirmed that atherosclerosis can begin as early as childhood. It can then slowly progress, undetected until adulthood when it may lead to a life-threatening situation.
Today, physicians don’t usually screen children for cardiovascular risk factors unless they are at exceptionally high risk. But considering the alarming rate of ]]>obesity]]> in American children, along with the knowledge that atherosclerosis can begin in childhood, some researchers are questioning whether it is now appropriate to begin screening children for cardiovascular risk?
A new study in the November 5, 2003 issue of the Journal of the American Medical Association found that high levels of low-density lipoprotein (LDL) cholesterol and high body mass index (BMI, a measure of weight in relation to height) in children were associated with increased artery wall thickness in young adulthood.
About the Study
This study included 486 participants who were between the ages of 4 and 17 in 1973, when the study began. For 23 years, the researchers kept track of the participants’ BMI, blood pressure, and blood cholesterol and triglyceride levels. In 1996, the researchers used ultrasounds to measure the wall thickness of the internal carotid artery (a major artery in the neck), which is considered a marker for atherosclerosis.
The researchers calculated how these cardiovascular (CVD) risk factors in childhood affected artery wall thickness in young adulthood. They also looked at the effect of having these risk factors in adulthood.
The children who had the highest LDL-cholesterol levels and highest BMI were significantly more likely to have increased artery wall thickness as young adults.
The cumulative effect of having high levels of LDL-cholesterol since childhood significantly increased the risk of having thicker arteries, while high levels of high-density lipoprotein (HDL, which is protective against CVD) since childhood decreased the risk. In adulthood, having high LDL cholesterol or systolic blood pressure increased the risk for thicker arteries, while having high HDL-cholesterol decreased the risk.
While interesting, these findings suffer from at least one important limitation. Rather than follow the participants for multiple decades to see which of them actually had a cardiovascular event (i.e., heart attack, stroke, or death due to CVD), the researchers relied on an intermediate marker, carotid artery wall thickness, to determine the extent their atherosclerosis. Although this marker is widely used as a substitute to assess cardiovascular health, it cannot perfectly predict the ultimate outcomes associated with CVD.
How Does This Affect You?
These findings suggest that cardiovascular risk factors in children may help predict cardiovascular risk in young adults. Another study in the same issue of the Journal supported these findings. Researchers in Finland found that the number of cardiovascular risk factors (cholesterol levels, blood pressure, BMI, and smoking) in children ages 12–18 was directly related to carotid artery wall thickness at ages 33–39.
How do risk factors in childhood lead to an increased risk of cardiovascular disease later? Not enough studies have been conducted to know for sure. But it is conceivable that the earlier atherosclerosis begins, the more severe it will become in adulthood. Also, excess fat in children may contribute to atherosclerosis by weakening the body’s defense mechanisms against the buildup of plaque.
Presently, the National Cholesterol Eduction Program recommends physicians begin measuring cholesterol levels at age 20. Should this age cutoff be lowered? New studies are needed to investigate the costs and benefits associated with cholesterol testing in younger children.
But there is little cost associated with assessing obesity in children, and many physicians are already calculating the BMI of their young patients. BMI is a simple calculation that only requires height and weight measurements.
What if you find out your child has risk factors for cardiovascular disease? Although nobody knows for sure, it is certainly reasonable to assume that taking action now can help prevent or delay the onset of cardiovascular disease in adulthood. Encourage your child to eat a healthful diet, get more physical activity, avoid smoking, and maintain a ]]>healthy body weight]]> . As of yet, cholesterol-lowering medications have not been proven safe and effective in children. Future research may uncover new methods of treating cardiovascular risk factors at a young age, when preventive treatments are presumably most effective.
American Heart Association
Heart and Vascular Diseases
National Heart, Lung, and Blood Institute
Atherosclerosis. American Heart Association website. Available at: http://www.americanheart.org/ . Accessed November 6, 2003.
Heart disease and stroke statistics—2003 update. American Heart Association website. Available at: http://www.americanheart.org/ . Accessed November 6, 2003.
Li S, Chen W, Srinivasan SR, Bond MG, Tang R, Urbina EM, Berenson GS. Childhood cardiovascular risk factors and carotid vascular changes in adulthood: the Bogalusa Heart Study. Journal of the American Medical Association . 2003;290:2271–2276.
What is atherosclerosis? National Heart, Lung, and Blood Institute website. Available at: http://123819272.net/Diseases/Atherosclerosis/ . Accessed November 4, 2003.
Raitakari OT, Juonala M, Kahonen M, et al. Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study. Journal of the American Medical Association . 2003;290:2277–2283.
Last reviewed Nov 7, 2003 by ]]>Richard Glickman-Simon, MD]]>
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