Parents' heart disease means problems for kids
Experts call for childhood prevention programs
Children whose parents develop coronary artery disease (CAD) by age 50 may go down the same road, unless families, physicians, and schools join together to head them off at the pass, experts say. Those children are more likely than others to be consistently overweight and to develop other cardiovascular risk factors such as elevated cholesterol and hyperglycemia at an early age, according to new findings from the Bogalusa (LA) Heart Study published recently in the Journal of the American Medical Association.1
Once they develop those risk factors, for many it's only a matter of time until they progress to heart disease themselves. That means that physicians, most of whom already monitor adults with a family history of CAD, need to start much earlier, says Gerald Berenson, MD, principal investigator of the Bogalusa Heart Study and director of the Tulane Center for Cardiovascular Health in New Orleans.
"The younger the parent was with coronary disease, the more serious the situation tends to be," Berenson says. "We've been studying risk factors in children in the Bogalusa study since 1972, and we've seen evidence of atherosclerosis even in 3-year-olds."
The Bogalusa Heart Study has collected periodic data on 14,000 individuals since 1972 to collect longitudinal, epidemiologic information on the early natural history of atherosclerosis. For this part of the study, 271 individuals with clinically verified parental history of CAD were compared with 1,253 people without such a history. Such measures as height, weight, body mass index, blood pressure, total serum cholesterol, and triglyceride levels were taken on each person. The findings were:
· Children with parental CAD history were consistently overweight throughout childhood. Severe obesity was twice as prevalent (7% to 8% vs. 3% to 5% in the control group).
· Increases in body mass index became apparent at a mean age of 10 to 11 years, total cholesterol at 15 to 18 years, LDL-C and glucose at 18 years, and insulin at 21 years.
· By adulthood, 35% of those with parental history were obese as measured by body mass index, compared with 26% of the control group. Also, 8.4% had high total cholesterol levels, compared with 4.8% of controls. And 2.7% had hyperglycemia, compared with 0.4% of controls.
'90s kids weigh more than '70s kidsAnother interesting trend was a general increase in kids' weight, Berenson says. In the 1980s, kids as a group tended to be about five pounds heavier on average than in the '70s. By the 1990s, they were 12 pounds heavier.
While genetic predisposition to CAD can't be changed, environmental factors that lead to such weight gain can, he says. The Tulane Center for Cardiovascular Health has designed several prevention programs based on knowledge gained in the Bogalusa study. "Health Ahead/Heart Smart" is designed for school use with kindergartners through sixth-graders. It provides a curriculum with sample lessons on general health and self-esteem, a nutrition manual including sample menus for the food service, and a physical activity guide. Another program called "Family Health Promotion" is a model eight- to 12-week intervention that increases knowledge, improves exercise and eating habits, and helps families learn to manage stress and quit smoking. (For more information and sample lessons, go to Tulane's Web site at http://www1.omi.tulane.edu/cardiohealth/.)
Linda Van Horn, PhD, RD, professor of preventive medicine at Northwestern University Medical School in Chicago, agrees that community partnerships that can work on prevention are urgently needed.
"Families need to take responsibility for this issue, and so do physicians and schools," she says. "This is a weak point in medicine that we bear no responsibility for connecting the risk of the child with the high-risk parent or grandparent. The tendency is to think that the child is healthy now, so we'll deal with the other problems later if they arise."
Parents and grandparents need to become aware that their children are at risk, Van Horn says, and they need to set good examples that will lay a foundation of long-term cardiovascular health. That may mean making changes themselves in their diet and exercise. Besides helping their children, parents with healthy lifestyles will be more likely to be able to care for their children for the long haul.
Physicians should set promoting good nutrition and exercise habits as a priority, much like they encourage children to wear seat belts and brush their teeth. They should certainly get the family medical history as part of regular physicals. "It's one thing to get the information and another to do something about it," Van Horn says. "Physicians are very busy, and parents of small children usually are more concerned about whether they're getting enough milk and growing properly than about heart disease. But they can make changes for a child as early as age 3 that will relate to the child's long-term health and lifestyle."
Schools need to get on the bandwagon as well, Van Horn says, starting with serving nutritious meals in the cafeteria. Physical activity should be required on a daily basis, especially in inner-city neighborhoods where children might not be able to play outside safely when they get home.
"The more kids learn that a healthy lifestyle is something you just do, the easier it is for them to perpetuate that for the rest of their lives," she says.
[For more information, contact Gerald Berenson, MD, director of the Tulane Center for Cardiovascular Health, 1501 Canal St., 14th Floor, New Orleans, LA 70112-2824. Telephone: (504) 585-7197.]
Reference1. Bao, et al. Longitudinal changes in cardiovascular risk from childhood to young adulthood in offspring of parents with coronary artery disease. JAMA 1997; 278:1,749-1,754.
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