Heart disease starts early in life: studies

Last Updated: 2003-11-04 16:00:22 -0400 (Reuters Health)

By Merritt McKinney

NEW YORK (Reuters Health) - Heart attacks and other complications of cardiovascular disease do not usually strike until middle age or later, but new findings add to growing evidence that cardiovascular disease begins in childhood.

In two new studies, the presence of cardiovascular risk factors such as high cholesterol and obesity during childhood and adolescence were directly related to signs of artery disease in early adulthood.

Based on the findings, it may be time to reconsider when best to start measuring cholesterol levels, according to an editorial published alongside the studies.

The editorialists -- Drs. Henry C. McGill Jr. and C. Alex McMahan, both at the University of Texas Health Science Center at San Antonio -- point out that measuring some risk factors, including obesity, smoking and high blood pressure, is cheap and beneficial at any age.

But they note that current guidelines do not recommend routine cholesterol testing before age 20 unless a child has a family history of early heart disease.

"With the evidence now emerging that shows that cholesterol and other risk factors do matter during adolescence, it may now be time to reconsider the age at which measurement of cholesterol levels should begin," McGill and McMahan suggest.

In one of the studies reported in this week's issue of the Journal of the American Medical Association, researchers found that obesity and high cholesterol in childhood were directly related to the thickness of the lining of the carotid artery. Thickening of this layer is a marker of the artery disease atherosclerosis.

The odds of artery thickening in young adulthood were directly related to levels of LDL cholesterol - the "bad" form of cholesterol - during childhood. People who had a higher body mass index (BMI), a measure of obesity that takes into account both weight and height, were also more likely to have artery thickening as young adults.

The study included 486 Louisiana adults ages 25 to 37 who had cardiovascular risk factors measured in childhood and adulthood.

The results show that "it is important to obtain a risk factor profile in childhood," lead author Dr. Gerald S. Berenson, of the Tulane Center for Cardiovascular Health in New Orleans, Louisiana, told Reuters Health.

He added, "It is also important for families and children to adopt healthy lifestyles -- prevention of obesity, increased physical activity, no smoking, good balanced diet."

The second study, led by Dr. Olli T. Raitakari at the University of Turku in Finland, provided similar results in a sample of more than 2,000 Finns ages 24 to 39.

Blood pressure, LDL cholesterol, cigarette smoking and BMI measured from ages 12 to 18 were directly related to the thickness of the carotid artery lining, the researchers report.

The relationship between risk factors in adolescence and the development of atherosclerosis in adulthood remained present even when the researchers took into account participants' risk factors as adults.

"Exposure to risk factors in childhood may contribute to the development of future atherosclerosis," Raitakari¹s team concludes. "These findings suggest that the prevention of atherosclerosis ... could be most effective when initiated in childhood or adolescence."

SOURCE: Journal of the American Medical Association, November 5, 2003


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