Heart Health in Children - Starts early

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From the Children's Hospital in Denver:

NOVEMBER 30, 2010.

Predicting Heart Health in Children

By RON WINSLOW

The vast majority of heart attacks happen to people well past middle age, so a

potential problem a half-century away may not be high on your list of child

health-care worries. But it is well-established that heart disease begins to

develop in childhood. Now, two new studies add to a burgeoning body of evidence

that developing heart-healthy habits as a youngster or adolescent may have

lasting benefits in adulthood.

One of the reports, based on a pooling of data from four major studies that

tracked people from early childhood into their 30s and 40s, suggests that the

presence of such risk factors as high blood pressure and abnormal cholesterol by

about age 9 strongly predicts a thickening of the walls in the carotid or neck

arteries in early adulthood. Experts consider this condition, called carotid

intima media thickness, a precursor to heart attacks and strokes.

Children who ate fruits and vegetables once a day had healthier arteries as

young adults than those who ate them less than twice a month.

..Risky Business

Four risk factors of heart disease:

High total cholesterol

High triglycerides or blood fats

High body mass index

High systolic blood pressure (the higher number)

Chances that children with these risk factors will develop early signs of

cardiovascular disease as adults, by age of initial diagnosis, compared with

children without risk factors:

Age 3: 1.17*

Age 6: 1.20*

Age 9 : 1.37

Age 12: 1.48

Age 15: 1.56

Age 18: 1.57

*Not statistically significant

Source: Circulation Digest

..The second study found that children who consumed fruits and vegetables once a

day had healthier arteries as young adults than those who reported eating fruits

and vegetables less than twice a month. Low consumption was associated with

stiffening arteries, a warning sign of future heart problems.

Both reports were led by researchers in Finland and are being published online

Tuesday by the American Heart Association journal Circulation.

The studies have limitations, however. In both cases, the risks in early years

are linked to other risks in adulthood—not to actual heart attacks or other

serious events. How reliable such surrogate markers are in predicting clinically

significant problems is in some dispute. Data on fruit and vegetable consumption

are based on how study participants described their monthly diet, not from a

rigorously controlled randomized study.

Nevertheless, says s, pediatrician-in-chief at Children's

Hospital, Denver, the findings " are part of an emerging and increasingly

consistent picture where lifestyle starting early in life is a very important

factor for long-term cardiovascular health. " Dr. s was a co-author of one

of the studies.

Interest in children's heart health is driven largely by the epidemic of

obesity, which has more than tripled in prevalence among children over the past

three decades, according to the U.S. Centers for Disease Control and Prevention.

Nearly one in five children between 2 and 19 years old is considered obese;

nearly one-third are overweight or obese. Obesity is associated with unhealthy

cholesterol and blood pressure and also heightens a person's risk of heart

attack.

Such statistics have many heart experts worried that more than four decades of

declining death rates due to cardiovascular disease, the Western world's leading

killer, may unravel if the problem goes unaddressed.

Amid a flurry of new research in recent years related to the adult consequences

of childhood heart risk, experts are now rewriting guidelines on how to track

and treat risk factors.

" It's pretty clear that the best scenario is never to have those risk factors in

the first place, " says Dr. s. " When you accumulate the impact of a risk

factor over time, that seems to be problematic. Interrupting it early is a good

concept. "

In one of the new reports, researchers led by Markus Juonala, of Turku

University Hospital, Turku, Finland, gathered data from four studies that

tracked heart risk in total of 4,380 people at three-year intervals beginning as

early as age 3 and followed them for more than two decades. In adulthood, they

underwent tests to detect thickening in the carotid arteries.

Children with high levels of four markers—total cholesterol; levels of blood

fats called triglycerides; a measure of body size called body mass index, or

BMI; and systolic blood pressure—were considered most at risk. Researchers found

that the presence of the risk factors at ages 3 and 6 had limited association at

best with thickened arteries in adulthood. But beginning at age 9, the risk

factors were significantly linked with evidence of disease when the carotid

artery test was taken between ages 20 and 45.

The finding is consistent with other research suggesting that risk factors begin

to become meaningful between ages 8 and 10, researchers said. It suggests that

age range might be the time for a thorough heart-risk evaluation, says Hugh

, a pediatric cardiologist at the Ohio State University College of

Medicine, Columbus.

Such a checkup might include measurements of BMI, cholesterol and blood

pressure, as well as questions about diet, exercise and exposure to second-hand

cigarette smoke, which has an impact on heart health, he says. (Some are already

routine features of a well-child exam.) Unlike adults, where specific

cholesterol, blood pressure and BMI targets are established, what constitutes

warning signs in children depends on age and other factors.

The second study, headed by senior author Mika Kähönen, of Tampere University

Hospital, Tampere, Finland, found that low consumption of fruits and vegetables

in both childhood and adulthood was associated with a higher likelihood of

arterial stiffness—a condition that typically develops with aging where the

arteries lose their elasticity, putting a potentially unhealthy workload on the

heart.

In the study, which tracked children ages 3 to 18, arterial stiffness was

determined by a test called arterial pulse wave velocity that was taken in

adulthood, ages 30 to 45.

Exactly how fruits and vegetables might keep arteries healthy isn't understood,

but the result is consistent with other research and long-standing

recommendations about the health benefits of fruits and vegetables—not to

mention your mother's persistent dinner-time pleas to eat your vegetables. " It's

amusing and nice when science confirms what your mother has been telling you

your whole life, " says Belamarich, attending pediatrician at the Heart

Healthy Program at the Children's Hospital at Montefiore Medical Center, New

York.