Young at Heart


Adopting a healthy heart approach to life when you are young is the best prevention approach to heart disease.

Promotion of healthy lifestyles in young people before the initial risk factors even occur is the ideal strategy when looking at limiting the development of heart disease later in life. Risk reduction early in life will reduce the burden of heart disease on healthcare.

Being overweight or obese is the major preventable risk factor that is increasingly being seen in the young.

Preventing obesity involves the development and maintenance of healthy life style behaviours, such as patterns of physical activity, a healthy diet and a smoke free lifestyle. These are called modifiable risk factors of heart disease.

The goal of so-called primordial prevention is to develop healthy behaviours and to maintain them over time. This prevents risk factors from developing.

Primary prevention focuses on children who already have risk factors. It aims to prevent the future development of symptoms of early heart disease.

There is no definitive proof that reducing specific risk factors in children will reduce the levels of symptoms of heart disease later in life. However, there is good evidence if you ignore them and do nothing that you will do harm, as the presence of risk factors is likely to result in early damage as a result of heart disease.

Most of this comes from the autopsies of young people who have died from other causes. The presence of heart disease damage has been found to correlate with risk factors such as lipid levels. More damage was seen the more the risk factors.

The presence of individual risk factors, such as raised blood pressure, raised body mass index (a measure of obesity), cigarette smoking, and raised lipid levels, are all additive in terms of the heart damage seen.

The presence of risk factors has also been associated with thickening of arteries in the neck region, a symptom of early heart disease, assessed in adolescents using a non-invasive medical imaging technique. This suggests adolescents may be a critical time for the development of early heart disease.

Tracking obesity and obesity related factors through adolescents it may be possible to study the impact of childhood behaviours.

Habits of physical activity and dietary intake develop early in childhood and are potentially modifiable in families and in schools.

Obesity is found with many of the risk factors of heart disease. If it is present at a young age, these other risks factors tend to cluster with it into adulthood. Also the more obese you are at an early age or into adolescence then it is more likely that you will be obese when you are older and at greater risk of heart disease. So adopting healthy lifestyle early really benefits.

The risk factors of heart disease that obesity clusters with include high bad lipid levels and low good heart protective lipid levels, diabetes, high blood pressure, sleep problems and thickening of the muscles in the left ventricle of the heart.

The clustering of these symptoms, called the metabolic syndrome, in adults is well documented and levels are well evidenced. However, it is not known what levels are likely in children to be causing early heart disease damage. The metabolic syndrome occurs in only 4% of normal healthy children but it rises to 50% in those who are overweight or obese.

The best prevention approach in the young is to prevent these symptoms that lead to early damage to the arteries and heart and the development of diabetes.

This primarily involves the prevention of BMI increases leading to overweight, obesity, and insulin resistance.

The obesity epidemic is global.

About 20 million children worldwide under 5 are overweight and obese. Ireland is the second worst country in Europe in terms of obesity.

In developing countries, there is the increasing prevalence of the double whammy of malnutrition and being overweight.

There is a need for reachable targets to be set that are specific to each nation.

Therapeutic lifestyle changes should emphasise patterns of physical behaviour and dietary intake. There should be an adequate trial of therapeutic lifestyle change before drugs are given to the young.

Some of the lifestyle changes to prevent obesity in the young are obvious but there is little in terms of guidelines.

Eating and exercise should be at a level to allow normal growth. There should be a restriction on the amount of time during the day spent on sedentary activity such as watching TV and playing computer games.

In a child’s diet there should be a focus on a healthy overall approach. Treats should not necessarily be excluded from the diet but should be treats and not the norm.

Some dietary recommendations to reduce obesity include intake of five fruits and vegetables, limiting sweetened drinks and beverage intake, avoiding saturated fats and trans fats (used in many frozen pizzas), limiting less refined products such as white breads, eating more fish, and reducing salt.

The recommended daily activity is 60 minutes of moderate to intensive physical exercise. This can be in 10 minute bouts. Vigorous physical activity at least 3 days per week is recommended and it is exercise that leads to muscle strengthening and bone strengthening should be part of that.

Compliance to good lifestyle factors needs to go hand in hand with better screening and identification of children with risk factors. Doctors should be looking for risk factors in children they see and advising on a healthy lifestyle.

The major aim should be the reduction of weight as this impacts directly on other risk factors such as lipid levels and high blood pressure.

Some children will need statins, but there is no evidence of any problems that may occur from giving these drugs for a lifetime starting early in childhood.

Adopting population based approaches at a national level targets reducing the risk levels of the general population. This involves adopting healthy lifestyle behaviour policies, in places such as schools, to reduce risk factors.

Promoting exercise and healthy eating through education will help highlight to younger people the importance of avoiding risk factors that lead to the early development of heart disease.

Conor Caffrey is a writer of science and medicine articles.

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