Cardiovascular diseases, such as heart attack and stroke, remain among the leading causes of death in the United States. According to the most recent Heart Disease and Stroke Statistics Update from the American Heart Association, about 15.5 million Americans aged 20 and older have coronary heart disease. They also estimate that every 84 seconds, a person will die from a heart attack.
Though there has been much effort to improve public awareness of such diseases, and to promote a healthy lifestyle, there is still much to be done.
It is well known that many of the precursors to cardiovascular disease in adulthood have their origins in childhood. This may be due to predisposing medical conditions or, as seen in the vast majority, behaviors that increase cardiovascular risk. The control of risk factors that lead to cardiovascular disease forms the basis of the field of preventive pediatric cardiology. For many of these factors, a healthy lifestyle can help control future cardiovascular risk.
▪ Obesity: It is estimated that one of every three children is overweight or obese. Obese teenagers are 16 times more likely to have severe obesity in adulthood, increasing their risk of hypertension, diabetes, heart disease and ultimately a decreased life expectancy.
So, how do we intervene? Prevention of obesity is key and begins with good habits early in life. Healthy eating with regular consumption of fruits, vegetables and whole grains is encouraged, avoiding sugary beverages and limiting fat intake. Additionally, we need to use our energy healthily. Increases in moderate to vigorous physical activity are associated with improvement in body fat, blood pressure, cholesterol and insulin resistance. The American Academy of Pediatrics recommends at least one hour of moderate-to-vigorous activity daily, and to limit total media time to no more than one to two hours of quality programming per day.
For those who may already be overweight or obese, it is important to continue follow-up with your doctor to check for associated illnesses and to monitor your progress in achieving a healthy weight. Maintaining a healthy lifestyle is most often a success when the entire family is involved.
▪ Hypertension: This condition is diagnosed if the average of the systolic or diastolic blood pressure taken on three separate occasions is at or above the 95th percentile for age, gender and height. It may be primary, which is often associated with obesity or a family history, or secondary to abnormalities of the kidneys, endocrine system or heart.
Blood pressure is checked routinely during well visits in children 3 and older. If there is a condition that increases the risk of hypertension, your pediatrician may begin monitoring the blood pressure at an earlier age. Hypertension is a risk factor for cardiovascular disease and should be controlled as early as possible. Treatment involves lifestyle modifications, and some children may require medication depending on the severity and cause.
▪ High cholesterol: Abnormalities in fat metabolism, also termed dyslipidemia or “high cholesterol,” may manifest as an increase in the total cholesterol, the “bad” low-density lipoprotein (LDL) cholesterol and triglyceride concentrations, and/or a decrease in the “good” high-density lipoprotein (HDL) cholesterol concentration in the blood. Children with high cholesterol are at significant risk of early atherosclerosis and premature cardiovascular disease, underscoring the need for early detection and treatment.
Universal screening is recommended for all children ages 9 to 11, and 17 to 21 in the absence of other risk factors. Earlier screening, beginning at age 2, is recommended for those with identified risk factors including a family history or high-risk medical condition. Management again includes healthy eating and regular vigorous exercise and, in some instances, medication for control of the high cholesterol.
▪ Tobacco exposure: In 2016, 2.2 percent of middle school students and 8 percent of high school students reported having smoked cigarettes in the past 30 days. Tobacco exposure is associated with atherosclerosis and is a risk factor for heart disease in and of itself. Providing a smoke-free environment is essential. Smoking cessation is encouraged, not just for the health of the smoker, but for others in the home who are also at risk due to second-hand smoke exposure.
Preventive cardiology involves nutrition, exercise and control of medical conditions contributing to cardiovascular risk. Identification of children who are at risk allows for early intervention in order to prevent cardiovascular diseases such as heart attack and stroke. Though the manifestations of these diseases are often seen in adults, the changes begin in childhood. As we approach this year, let us keep maintaining a healthy lifestyle at the forefront. The benefits are to be seen not only in this generation but for generations to come.
Mohanageetha Ardhanari, M.D., is a pediatric cardiology fellow at Holtz Children’s Hospital at the University of Miami/Jackson Memorial Medical Center. Juanita Hunter, M.D., is assistant professor of pediatrics in the Division of Pediatric Cardiology at the University of Miami Miller School of Medicine.