A Pediatric Opportunity in Adolescents to Prevent Adult Heart Attacks

Abstract

Importance: Cardiovascular disease is the number one cause of death in the adult population, greater than all cancers combined. When a heart attack or stroke occurs, many individuals have no advance warning, thus making prevention difficult. Cardiovascular disease begins early, i.e., in the developing fetus, and progresses throughout childhood and adolescence, such that it is identifiable both radiographically and ultrasonographically in the adolescent. Observations: There are multiple lines of evidence that atherosclerosis is present in the pediatric population. This evidence is based on autopsy studies in accident victims, coronary artery calcium scoring and carotid intermedia thickness measurements, intravascular ultrasound studies of hearts transplanted from teenage accident victims, and wartime casualties in young males. Multiple studies of cardiovascular risk factors (e.g., hypertension, obesity, insulin resistance, glucose intolerance and hyperlipidemia) have emphasized their importance in contributing to the pathogenesis of atherosclerosis. With the recent increase of obesity in the pediatric population, these risk factors will assume increasing importance in the development of clinical cardiovascular disease in the adult population. Prevention of atherosclerosis will require measuring a lipid profile in adolescents and initiating intervention to reduce the triglyceride and LDLc concentration. Education of both the adolescent at risk and his/her family will be necessary. Lifestyle changes are paramount. Hyperlipidemic medication should be reserved for individuals with severe lipid abnormalities. Conclusion and Relevance:Atherosclerotic changes of arteries begin during gestation and progress throughout the pediatric years into adulthood. Pediatricians’ contribution to reducing the progression of atherosclerosis in their patients can have major effects in controlling this epidemic in adults. Education of adolescents and their parents concerning a healthy lifestyle is paramount to a successful cardiovascular disease prevention program.