Risk Factors for Coronary Artery Disease Often Begin in Childhood

Many of us think of heart disease as something that affects older people. "In fact, the risk factors for developing coronary artery disease (CAD) start in childhood, and that's where prevention needs to begin as well," says Dr. J. Timothy Bricker, professor and chief of the Lillie Frank Abercrombie Section of Cardiology in the department of pediatrics at Baylor College of Medicine and chief of the Texas Children's Hospital cardiology service and the department of pediatric cardiology of the Texas Heart Institute.

Dr. J. Timothy Bricker and young patient.

Traditionally, cardiologists have focused on the prevention of heart attacks and the management of complications once heart disease has developed. "But there is something we can do on an even more basic level," says Dr. Bricker, "and that is prevent the risk factors from developing in the first place." This prevention is part of routine general pediatric care, so while it is important to pediatric cardiologists, it is even more important to pediatricians, family physicians and practitioners in well-child clinics.

Dr. Bricker outlines six of the most important modifiable risk factors in the development of coronary artery disease and notes that primary care practitioners can play an important role in educating families about the importance of those factors.

DIET
Healthy eating for healthy hearts begins in childhood. While low-fat diets are not recommended - and may in fact be harmful - for newborns and young infants, fat intake for school-age children does need to be considered. School lunches have made this a challenge for parents over the years. Dr. Bricker notes that investigators at The University of Texas-Houston Health Science Center have begun to make a big impact in HISD schools in this regard. He points out, too, that pediatricians have the responsibility to help children develop healthy eating habits. This can be done by providing education or reinforcing recommendations of a dietitian. Education is critical to helping kids get healthy meals and snacks, and many times that education has to extend to the entire family. "At Texas Children's Hospital, cooking classes provided by the Wellness Center have proven very popular," says Dr. Bricker. Pre-teens and teens not only learn about good nutrition from registered dietitians, they also learn how to prepare healthy meals - and they go home armed with recipes and good information to share with other family members.

SMOKING
"Smoking is the most preventable of the risk factors for coronary artery disease," notes Dr. Bricker. "There is no downside to not smoking." Children whose parents smoke are more likely to do so themselves. Peer pressure also continues to present a huge challenge to children today. Proportionally, smoking is on the rise among young women, a group to whom tobacco is marketed as a means to reduce weight. At Texas Children's Hospital, Dr. Marianna Sockrider, pediatric pulmonologist, has spearheaded a project to teach parents and children how to stop smoking. Such programs are especially important, Dr. Bricker notes, when one considers the risk factors that smoking poses. Middle-aged men with high cholesterol triple their risk for heart disease; the same is true for middle-aged men who smoke. But for middle-aged men who have high cholesterol and smoke, the risk for developing coronary artery disease increases 16 times. "When smoking is involved," says Dr. Bricker, "the risk factors don't just add up; they multiply."

PHYSICAL INACTIVITY
As a society, Americans are more physically inactive than ever - partly because they spend so much time in front of the TV. But again, changing this pattern requires a commitment from everyone in the family. Trading television time for physical activity time is something family members can do together. "What we have found," says Dr. Bricker, "is that physical activities have to be fun and easy - and that's true for both adults and children. You don't have to lift weights and run three miles a day to increase your heart rate and help keep your heart healthy, but it does require regular aerobic exercise of at least moderate intensity." According to the AHA, physical inactivity is a major risk factor for heart attack and stroke. In fact, each year about 250,000 deaths in the United States are attributed to the lack of physical activity. For cardiovascular fitness, the AHA recommends at least 30 minutes of physical activity, three to four days a week.

HIGH BLOOD PRESSURE (HYPERTENSION)
High blood pressure tends to run in families and can develop as a risk factor for CAD as early as the pre-teen or teen years, although it is more common later in life. Dr. Darwin Labarthe of the UT-H School of Public Health, along with co-investigators at UT and Baylor College of Medicine, are conducting a study with children in The Woodlands and in Japan to evaluate the development of risk factors during adolescence. Analysis is in progress. The normal rise in blood pressure from childhood to adult years is one of the areas of focus for this research. "High blood pressure is not extremely prevalent in children," says Dr. Bricker. "Children should, however, have their blood pressure checked on an annual basis as part of their routine pediatric care after age 3."

CHOLESTEROL
Like hypertension, high cholesterol often runs in families. "Children with family members who have early coronary disease or known cholesterol abnormalities need lipid testing at about the time they are kindergarten age," says Dr. Bricker.

OBESITY
Obesity is one risk factor for coronary artery disease that can lead to the development of other risk factors including abnormal blood lipids, diabetes and hyper- tension. "Obesity tends to run in families as well," says Dr. Bricker, "and intervention has to involve the whole family to be effective." Studies have shown a link between obesity in childhood and hours spent in front of the TV. Pediatricians and other caregivers can help by educating families about the importance of being physically active. Diseases like diphtheria, rheumatic fever and congenital rubella that caused childhood heart disease just a few generations ago are rarely seen today because of advances in preventive medicine. "Now," says Dr. Bricker, "our challenge is to take primary care to another level and help prevent the risk factors for coronary artery disease from ever developing."

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©2006 Texas Medical Center

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