10-Year-Olds at Risk for Future Heart Attacks and Stroke

Seemingly healthy kids as young as 10 can have stiffening of the arteries—an early warning sign of future heart attack or stroke risk in adulthood. That shocking discovery was reported in a new study published in Pediatrics. The study also found a simple way to identify at-risk kids and young adults.

Researchers from Cincinnati Children’s Hospital Medical Center (CCHMC) reported that information from a standard cholesterol test can accurately predict which kids are likely to have abnormally stiff arteries—a disorder that has been strongly linked to higher risk for both heart attack and stroke in adults.

This abnormality, also known as “hardening of the arteries,” is an indication of accelerated arterial aging (meaning that the kids’ arteries are “older” than their chronological age). Stiff arteries during childhood could magnify the danger of suffering life-threatening cardiovascular events at an unusually early age as adults, says lead study author Elaine Urbina, MD, director of cardiology at CCHMC.

The good news is that lifestyle changes, such as weight loss, more exercise, and a healthier diet, can dramatically reverse children’s cardiovascular risks if they’re caught early,” emphasizes Dr. Urbina.

A Generation At Risk

“If parents and healthcare providers don’t work harder to change their children’s poor lifestyle habits, we’ll be flooded with cases of young adults suffering heart attacks, strokes, or new-onset cases of type 2 diabetes, the fastest growing disease in the world,” says Bradley Bale, MD, medical director of the Heart Health Program for Grace Clinic in Lubbock, Texas.

“Because so many of today’s children are overweight, inactive, and eat a sugary, high-fat diet, many experts predict that unless these trends are reversed, this generation of children will be the first in modern history to live shorter lives than their parents,” due to cardiovascular disease (CVD), the leading killer of Americans and other chronic diseases, warns Dr. Bale.

Another new study, published in Neurology, highlights that childhood risks can have a lifelong impact. The investigators studied more than 24,000 people (average age 65) and found that living in the Southeast US—sometimes called “the stroke belt,” due to the high rate in that part of the country—between ages 13 and 18 boosted risk for stroke by 17 percent, even if people subsequently moved to other areas.

The link held true even when cardiovascular risks like smoking and obesity were taken into account. One theory is that the health habits we develop during childhood carry through to adult life. It may also be environmental factors, such as exposure to secondhand smoke, air pollution, toxins, or germs play a previously unsuspected role in CVD.

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How to Tell If Kids Are in Cardiovascular Danger

In the Cincinnati study, the doctors analyzed a measurement called triglycerides-to-HDL (TG/HDL) ratio, calculated by dividing the level of triglycerides (a type of blood fat) by the level of HDL (good) cholesterol. “Research shows that this ratio accurately predicts which people have small dense LDL (bad cholesterol) particles, the most dangerous kind,” says Dr. Urbina.

Some LDL cholesterol particles are big and fluffy—and tend to bounce off artery walls. Others are small and dense, allowing them to more easily penetrate the blood-vessel lining and clump into plaque. “Think of the difference between beach balls and bullets,” says Dr. Bale.

The study, which included about 900 participants ages 10 to 26, found that the more abnormal the patient’s TG/HDL ratio was, the more likely the person was to have abnormally stiff arteries. About one-third of the seemingly healthy kids in the study had stiff arteries. The study found a progressive rise in stiffness as the TG/HDL ratio increased. This suggests that an abnormal TG/HDL ratio accurately predicts which kids will have rigid blood vessels (as measured by three types of tests used in the study).

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What Parents Can Do

“While few, if any, pediatricians look at children’s TG/HDL ratios, this information can easily be calculated from the numbers on a standard cholesterol test,” says Dr. Bale.  The optimal ratio varies according to a person’s ethnicity.

Dr. Urbina advises having kids’ cholesterol checked once, between ages 9 and 11 (or at an older age, if your child hasn’t been checked previously), as advised by national guidelines from the NIH. If the results are abnormal, she recommends a thorough medical evaluation of your child’s weight, height, blood sugar, and insulin levels.

The first line of treatment is an improved lifestyle, including regular exercise, weight loss, and cutting down or eliminating sugary drinks, potatoes (particularly French fries), white rice and pasta, says Dr. Urbina. This frequently reverses heart risks—including insulin resistance (also the root cause of type 2 diabetes), says Dr. Urbina.

For cases that don’t respond to these healthy changes, Dr. Urbina also treated kids who have high triglycerides and low HDL with a prescription form of fish oil, a FDA approved therapy.  She’s had excellent success using these therapies on her young patients. “My goal is to put adult cardiologists out of business.” 

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