HEART DISEASE IS THE leading cause of death in the U.S. But for most with atherosclerosis – or hardening of the arteries, the most common cause of cardiovascular disease, which can lead to heart attack and stroke – it doesn’t catch up with them until later in life. Yet what happens physiologically from lifestyle choices made decades prior can have a significant impact, even tracing all the way back to parents’ choices before a child is born.
For kids with congenital heart disease, certainly this is a point of focus from a young age. Some kids born with heart defects require surgery. But there’s reason to consider long-term cardiovascular health in other children as well, as the origins of heart disease that isn’t congenital can still have roots in childhood and adolescence. “We know that these problems and what’s called atherosclerotic heart disease – where you have lipid or cholesterol buildup in arteries – can begin at a very early age,” says Dr. Gregory Perens, a pediatric cardiologist at UCLA Mattel Children’s Hospital in Los Angeles.
Beyond genetics, the earliest risk factors include maternal smoking while the child is still in utero. From 0 to 12 months, experts advise breastfeeding, and doing so exclusively for the first 4 to 6 months – as the sole source of nourishment for the baby; this has been found to lower a child’s later risk of heart disease, compared with bottle feeding, Perens notes. “Obviously not all children can be breastfed,” he says. “But if that’s possible, that’s the recommendation.”
Fast-forwarding, as children get older, not only do parents but kids, too, have a say in reducing health risk factors. For teens in particular – as they begin to take the reins in other areas of their lives – doctors say this is great time to begin prioritizing heart health and, with support from parents, to work together as a family to lower their risk for developing heart disease.
[See: 10 Things Pediatricians Advise That Parents Ignore – and Really Shouldn’t.]
It’s important to heed genetic factors that can increase risk – like a condition called familial hypercholesterolemia that occurs in about 1 in every 250 to 500 people (estimates vary). However, experts say, it’s key not to overlook the broad impact of lifestyle for all kids and adults, which tends to be greater for the majority of people. “In the analyses that have been done, genetics probably plays a role that is relatively minor compared to lifestyle,” says Dr. Stephen Daniels, chair of the department of pediatrics at the University of Colorado School of Medicine, and pediatrician in chief at Children’s Hospital Colorado in Aurora. “When you’re talking about the development of these risk factors, which would include high blood pressure, abnormal cholesterol, obesity, diabetes and cigarette smoking, a lot of the emphasis really should be on lifestyle,” says Daniels, a pediatric cardiologist who focuses on prevention.
Of course, Daniels and other experts are quick to point out that it can be easier said than done – as with adults – to make healthy changes, like eating better, exercising more and getting ample sleep. Adolescents face a wide range of challenges, like peer pressure to engage in risky behavior. While teen smoking rates have declined, vaping or e-cigarette use is still quite popular among teens, and these can have levels of nicotine not only on par with but sometimes higher than traditional cigarettes. “That nicotine is what increases their blood pressure, increases their heart rate – and therefore puts them at risk for not just heart disease, but obviously lung disease, by inhaling that,” Perens says. For those and many other reasons, kids are advised not to smoke at all – or anything – or to quit if they do. “No cigarettes, no hookah, no e-cigs,” says Dr. Karol Watson, a professor of medicine and cardiology and co-director of the UCLA Barbra Streisand Women’s Heart Health Program. “Even one cigarette a day increases heart risks.”
She directs UCLA’s Teen Heart Health Program. “I run the cholesterol and hypertension clinics at UCLA, and about five years ago we noticed a worrisome trend. We were getting more and more referrals for teenage patients with high blood pressure and high cholesterol,” she says. “We knew that if this many young people were having uncontrolled risk factors we could be heading [toward]an epidemic of young and middle aged adults with heart attacks.” That led to development of the Teen Heart Health Program, through which teens educate their peers about heart healthy behaviors. Today, those teens are also involved with the Early Cardiovascular Health Outreach SMS, or ECHOS project. “This is a UCLA-based research project testing whether delivering educational health messages to teens and young adults via text messages can alter behavior,” Watson explains.
Getting the word out about heart healthier alternatives to everyday life choices is hard work, whether the audience is adults or teens. The ubiquitous nature of screens – from phones to tablets – leads to a lot of sitting. But, as noted in the National Heart, Lung, and Blood Institute’s summary report of guidelines for cardiovascular health and risk reduction in children and teens, it’s recommended that 11- to 17-year-olds get at least an hour of moderate to vigorous activity daily, like jogging, including three days of vigorous, intense physical activity, such as running or playing soccer.