Risks for atherosclerosis affect adolescents, adults
Risks for atherosclerosis affect adolescents, adults
Prevention efforts should begin in teen years
Risk factors long blamed for atherosclerosis in adults are already doing their dirty work in the teen years, according to a lengthy study on people ages 15 to 34.
The landmark study, sponsored by the National Heart, Lung, and Blood Institute (NHLBI), based in Bethesda, MD, also showed that smoking, obesity, hypertension, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) affect the development of heart disease about equally in men and women and blacks and whites.
"A major implication is that prevention is likely to be much more effective if it’s started early in life, at least by the teen-age years," says Henry McGill, MD, senior scientist emeritus at the Southwest Foundation for Biomedical Research in San Antonio, TX. He was the lead author of an article on the study in the January issue of the Arteriosclerosis, Thrombosis and Vascular Biology Journal.
That article focused on the effects of three risk factors HDL, LDL, and smoking found in the "Pathobiological Determinants of Atherosclerosis in Youth," or PDAY, study. Previous papers from the same study showed that obesity and hypertension also influence atherosclerosis (hardening of the arteries) at an early age, McGill said.
The study is significant because it extended research to women and to people in their teens and 20s, says Basil Rifkind, MD, Senior Scientific Advisor for the NHLBI Vascular Research Program.
"It’s another piece in the jigsaw," Rifkind says. "It fits into the general concept of heart disease high cholesterol aggravated by high-blood pressure or smoking leads to the disposition of fat in the arteries." PDAY gathered data from autopsies of 1,079 men and 364 women ages 15 to 34 who had died from an accident, homicide, or suicide. The study analyzed tissues and measured the blood levels of HDL, LDL, and thiocyanate, a chemical marker for smoking.
The autopsies were done between 1985 and 1994, although McGill says he and other pathologists, including Dr. Robert W. Wheeler of the University of Chicago Medical Center and Dr. Jack P. Strong of the Louisiana State University School of Medicine, had talked about the importance of conducting such research for years before that.
"We had some hints that atherosclerosis started in childhood," Rifkind says. "Autopsies done during the Korean War found young servicemen to have extensive fatty deposits in their arteries. That was confirmed to some extent in the Vietnam War."
Research on young is scarce
However, the 1952 Korean War study speculated that the causes included stress and contained no information about the risk factors. "That was even before the term risk factor’ was used," McGill says.
The PDAY study confirmed that advanced lesions occur in young people. The pathologists were able to link them with risk factors that research has identified during the 45 years since the Korean War study.
"We can also say that the differences between men and women are not due to differences in any of these commonly recognized risk factors," McGill says. He says that while the women in the study had less atherosclerosis than the men, the risk factors increased the incidence by the same proportion in men and women.
The differences, he says, lie somewhere else, perhaps in the hormones. "The research is significant in that it fits in well with the overall concept that high cholesterol leads to heart disease," Rifkind says. "We think high cholesterol is often due to diet, and young people in America eat high animal fat diets, just as their parents do."
A panel on cholesterol in childhood recommended several years ago that children after the age of two eat with the same dietary recommendations as the rest of the family less than 30% of calories from fat and less than 10 % from saturated fat.
However, that message wasn’t taken to heart by much of the medical community.
"I think this study will contribute considerable weight to those recommendations that the more aggressive public health people have been advocating for about 15 years," McGill says. Among the concerns that are given more weight by the PDAY study are smoking by young people and fat-laden fast food and school lunches.
Patient education starts early
Another study, released in March by the NHLBI, found that young people can be taught behaviors that could protect them against heart disease later in life. The trial, involving nearly 100 elementary schools in four states, targeted children’s behaviors and the school environment. Called CATCH (Child and Adolescent Trial for Cardiovascular Health), it worked with administrators, teachers, physical education specialists, and food service staff to change cafeteria offerings to healthier, lower-fat choices, increase students’ enjoyment of and participation in moderate to vigorous activity, help them make better food choices, and coach them on how to resist social pressures to start smoking.
The CATCH study suggested that the behaviors could be taught through a cost-effective program and with only minimal training of school personnel, according to the report in the March 13 issue of the Journal of the American Medical Association.
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