Research News

Kids and Heart Disease: The Heart of the Matter

Heart disease risk factors grow in Canada's teens

NEW YORK (Reuters Health) October 27, 2009 –– An alarming number of Canadian teenagers has high blood pressure, high cholesterol or other major risk factors for heart disease and stroke, a researcher warned Tuesday at a conference in Edmonton, Alberta.

"This study is further evidence of an accelerating decline in the heart health of Canada's teens," Dr. Brian McCrindle, a cardiologist at The Hospital for Sick Children in Toronto, told the Canadian Cardiovascular Congress 2009, co-hosted by the Heart and Stroke Foundation of Canada and the Canadian Cardiovascular Society.

"The disturbing thing is the trends we found show that the situation is getting worse in some areas and at best is unchanged in others," McCrindle added in a telephone interview with Reuters Health.

The findings stem from a 7-year ongoing study of the heart health of more than 20,000 Canadian 14- and 15-year-old 9th grade students.

The data suggest that between 2002 and 2008, the percentage of kids with one or more risk factors for heart disease rose from 17 percent to 21 percent; the number with high cholesterol rose from 9 percent to 16 percent; and the number of obese teens rose from 11 percent to 13 percent.

The number of teens with high blood pressure fell slightly from 19 percent to 17 percent and the number overweight fell from 17 percent to 16 percent.

Still, "almost a third of these teenagers are either overweight or obese," McCrindle said, "and this is due to a lot of adverse, health behaviors: poor nutrition, consuming a lot of sugary drinks, skipping breakfast, lack of physical activity and increased time spent in sedentary pursuits."

"Over 50 percent of Canadian children between the ages of 5 and 17 aren't active enough to support optimal health and development," Dr. Beth Abramson, spokesperson for the Heart and Stroke Foundation of Canada, noted in a prepared statement.

"What does this say for the future health of these young teens? They are at risk of developing long-term health effects such as premature heart disease and type 2 diabetes," she warned.

Studies have shown that overweight or obese kids with heart disease risk factors often grow up to be overweight or obese with heart disease risk factors.

"While public awareness has increased around this issue, it hasn't yet translated into any kind of policy action and it certainly hasn't translated into behavior changes to correct some of these factors," McCrindle told Reuters Health.

Comprehensive and integrated guidelines, he added in a statement, are needed "for keeping our children healthy and we need them soon because this type of study is showing the worst is yet to come."

"This is the first generation of children that may have a shorter lifespan than their parents," McCrindle warned.

For more information on the study, please visit:

Patterns: For Heart Attacks, Shifts in Gender Gap
By Roni Caryn Rabin

(The New York Times) October 27, 2009 –– Middle-aged men are at much greater risk of a heart attack than women their age, but new research suggests that the gap may be narrowing.

Some 2.5 percent of men ages 35 to 54 who responded to national health surveys in the late 1980s and early 1990s reported having had a heart attack, compared with 0.7 percent of women the same age. But in more recent health surveys, conducted in 1999 to 2004, the percentages for women rose to 1 percent while dropping to 2.2 percent for men.

The researchers acknowledged that the reported increases and decreases might have been due to chance. But the lead author of the study, published in the Oct. 26 issue of The Archives of Internal Medicine, said the changes reflected an “ominous trend.” And the article noted that over the same period, men’s scores on a scale that predicts heart disease risk improved slightly, while women’s scores worsened.

"I think everyone has been complacent that women are not at very high risk at this age," said the lead author, Dr. Amytis Towfighi, an assistant professor of clinical neurology at University of Southern California. "This is a wake-up call for everyone to pay more attention to cardiovascular risk factors in midlife."

A 2007 study by the same authors found that women ages 45 to 54 were twice as likely as men to report having had a stroke, a finding that challenged conventional medical thinking that women were at lower risk for stroke in midlife than men.

The studies analyzed information gathered by the National Health and Nutrition Examination Surveys, a nationally representative sample of the population that included 5,112 men and women ages 35 to 54 in the 1988-94 survey and 4,594 in that age range in the 1999-2004 survey.

Among men, systolic blood pressure and HDL cholesterol improved over time and smoking rates dropped, the study found. Among women, only HDL improved; smoking rates, blood pressure and total cholesterol profiles remained unchanged. Rates of obesity and diabetes increased in both sexes over time; obesity is more prevalent among women.

Heart Risk Factors on the Rise Again

Hypertension, Diabetes, and Obesity Are Increasing After Decades of Improvement

HealthDay Reporter by Jennifer Thomas
WebMD Health News

Sept. 16, 2009 –– The percentage of Americans without major heart disease risk factors rose during the 1980s and 1990s, but our health is declining again, a study shows.

Though the percentage of smokers is still heading south, the number of people with obesity, diabetes, and high blood pressure is increasing, shows the study published in Circulation: Journal of the American Heart Association.

"It's not good news," study researcher Earl S. Ford, MD, MPH, of the U.S. Public Health Services at the CDC, tells WebMD. "The effect of all this stuff is going to be determined by the balance of the risk factors."

In a news release, Ford says that "from a preventive health point of view, it's important that individuals achieve as many of these [low-risk] goals as possible, and it's disappointing that less than 10 percent of Americans are meeting them all."

Trends in Heart Disease Risk Factors

About one in 12 adults in the U.S. had a low-risk profile for cardiovascular disease during the 1994-2004 period, he tells WebMD, and that needs to improve.

Ford adds in the news release that the study "suggests that achieving low risk status for most U.S. adults remains a distant and challenging goal. Unfortunately, the limited strides that were made toward this goal during the 1970s and 1980s were eroded by the increases in excess weight, diabetes and hypertension during more recent decades."

Ford's team analyzed data on adults aged 25-74 in four national surveys, examining the prevalence of a low-risk profile for heart disease, which includes all of the following:

In many studies, the researchers say, people with a low-risk profile have lower health care costs and are far less likely to develop cardiovascular disease.

In the present analysis, they found that 4.4% of adults had all five of the low-risk factors between 1971 and 1975. That rose to 5.7% in the 1976-1980 National Health and Nutrition Examination Survey, and rose again to 10.5% in 1988-1994. But the trend did not continue and the proportion of adults rating at low risk in 1999-2004 fell to 7.5%.

"Until the early '90s, we were moving in a positive direction, but then it took a turn and we're headed in a negative direction," Ford says in a news release. "When you look at the individual factors, tobacco use is still headed in the right direction and so are cholesterol levels, although that has leveled off. The problem is that blood pressure, BMI and diabetes are all headed in the wrong direction."

Physical Activity and Obesity

An imbalance in the amount of energy consumed in food and the amount expended in physical activity is likely a major culprit in the negative risk factor trends, Ford says. "Addressing this imbalance, by people becoming more active and eating less, would reduce overweight and obesity, which in turn would help to lower blood pressure and prevent diabetes."

The study also shows that:

Rob M. van Dam, PhD, and Walter Willett, MD, PhD, of Harvard Medical School and Brigham and Women's Hospital, say in an accompanying editorial that the findings of this latest survey are disturbing, especially since they don't yet reflect the effects of the current epidemic of childhood obesity.

"Much potential exists to reverse ominous trends in cardiovascular risk factors and mortality in the United States, but this is unlikely to occur without making prevention of overweight and obesity a clear national priority," they write.

Sources: News release, American Heart Association. Ford, E. Circulation: Journal of the American Heart Association. Van Dam, R. Circulation: Journal of the American Heart Association. Earl S. Ford, MD, MPH, CDC.

Healthy diet keeps kids' blood pressure in check
SOURCE: Hypertension, June 2009.

NEW YORK (Reuters Health) June 15th, 2009 –– Restricting the amount of saturated fat in the diet from infancy until age 15 years leads to "meaningful" decreases in blood pressure in children and adolescents, which could have a huge impact on future cardiovascular health, Finnish researchers report.

Dr. Harri Niinikoski from the University of Turku and colleagues found that blood pressure was lower in children and adolescents fed a low-saturated-fat, low-cholesterol diet since infancy relative to children and adolescents fed a standard diet.

In the long-running study, investigators compared 540 children assigned from infancy to a dietary counseling group to 522 who did not get special diet advice.

Breastfeeding or formula was advised during the first year of life. After 12 months of age, families and children in the intervention group received regular counseling about the benefits of avoiding saturated fats, while the "control" group received basic health education routinely given at well-baby clinics and school health care; no suggestions on the use of fats were given to these families.

The researchers previously reported that dietary counseling led to diets lower in fat and saturated fat, and reduced blood cholesterol levels in children up to the age of 14.

They now report in the journal Hypertension that blood pressure, measured every year from 7 months to 15 years of age, was roughly 1 point lower in the boys and girls fed a low-saturated-fat diet since infancy compared to those fed a standard diet.

This 1-point lower blood pressure in children eating a low-fat diet, if maintained, "might have an immense effect" on future blood vessel health, the researchers point out.

The study also found that, throughout childhood, blood pressures were higher in children of parents with hypertension (high blood pressure) relative to children of parents with normal blood pressure.

"Children of hypertensive parents are already prone to higher blood pressures in early childhood," Niinikoski and colleagues warn. The current observations "strongly emphasize" the importance of preventing high blood pressure in children, in general, and especially in those with a family history of high blood pressure, they conclude.

Overweight Preschoolers Raise Their Heart Disease Risk
HealthDay Reporter by Jennifer Thomas

(HealthDay News) March 11, 2009 –– In yet another sign that obesity poses health risks at any age, new research shows that overweight children as young as age 3 can begin to show signs of cardiovascular disease risk factors.

About 24 percent of U.S. children aged 2 to 5 are overweight, defined as having a body-mass index (BMI) in the 85th percentile or above for their height and age. That number rises to 33 percent among children aged 6 to 11, according to the U.S. Centers for Disease Control and Prevention.

Using data on 3,098 children aged 3 to 6 taking part in the National Health and Nutrition Examination Survey, researchers analyzed levels of HDL, or "good," cholesterol and C-reactive protein, a marker for inflammation that can warn of cardiovascular disease.

They found that children with high BMIs and large waist circumferences were more likely to have elevated levels of C-reactive protein and lower levels of HDL cholesterol than children of normal weight. Data on LDL, or "bad," cholesterol was not available.

"Overall, as waist circumference and body-mass index increases, HDL cholesterol decreases and C-reactive protein increases," said study author Sarah Messiah, a research assistant professor at the University of Miami. "It's pretty clear that even at this young age, these cardiovascular risk factors are in motion."

The findings were expected to be presented Wednesday at the American Heart Association's Cardiovascular Disease Epidemiology and Prevention annual conference, in Palm Harbor, Fla.

About 12 percent of children aged 2 to 5 are obese, defined as having BMIs in the 95th percentile or above for their height and weight, according to the CDC. Among children aged 6 to 11, 17 percent are obese.

In the study, researchers noted that links between children's weight and levels of cholesterol and C-reactive protein varied according to ethnicity, gender and race.

Elevated BMI and waist circumference significantly predicted higher C-reactive protein levels in white girls and in black and Hispanic boys.

High BMI and waist circumference predicted lower HDL cholesterol in Hispanic boys and girls, while a high BMI was linked to elevated total cholesterol in black boys.

Researchers said the differences could have to do with the children's diets, genetics or other lifestyle factors.

But researchers stressed that the key message of the study was that all children should have their BMI and waist circumference monitored, and if the numbers are found to be creeping up, doctors and parents should intervene.

"It's frightening," Messiah said. "We are in uncharted territory. We have never had this number of children this heavy so young. We don't know the cumulative effect of all of these years of having all of your organs –– heart, kidneys, liver, heart, pancreas –– under stress from being overweight."

While worrisome, the findings are not surprising, said Dr. Ronald Krauss, director of atherosclerosis research at Children's Hospital Oakland Research Institute. In adults, the relationship between obesity and elevated LDL cholesterol and C-reactive protein has been well established.

"It reinforces how serious it is and how much of an effort it's going to take to reduce the risk by going back to early childhood," Krauss said.

This summer, the American Academy of Pediatrics recommended children as young as 2 start having their cholesterol levels screened if they have a family history of heart disease or high cholesterol, and that screening should start no later than 10.

They also recommended, controversially, that children as young as 8 be given cholesterol-lowering drugs.

Both Messiah and Krauss are opposed to children aged 3 to 6 taking statins; the focus should instead be on better nutrition and more physical activity.