ATLANTA, Nov. 9 -- Although symptoms of heart disease may not show up until a person is middle-aged or older, a new study presented today at the American Heart Association Scientific Sessions finds heart disease actually begins developing in childhood.
The study of transplant hearts from teenage donors found that one in six of them had significant blockages, or plaque, in at least one coronary artery, a blood vessel that feeds blood to the heart.
These findings support American Heart Association recommendations that heart disease and stroke prevention should begin early in childhood -- before smoking, bad dietary habits, and other causes of heart disease and stroke, such as high blood pressure, physical inactivity, obesity or diabetes, become established, says the senior author of the study, E. Murat Tuzcu, M.D., director of the Intravascular Ultrasound Laboratory, at the Cleveland Clinic Foundation, Cleveland, Ohio.
Although evidence of early atherosclerosis has been seen in autopsy studies of young people killed in accidents or by other non-disease related causes, no previous study ever took such a close look into living hearts from apparently disease-free young people. Atherosclerosis occurs when fatty substances, such as cholesterol, or other materials deposit along the inner lining of an artery. These deposits can build up, leading to blockages that restrict the flow of blood in the arteries and can cause a heart attack.
"In this particular study, the focus was not the factors that lead to disease in children," says Tuzcu. "However, these findings should raise the public's awareness that heart disease is not just a disease of the elderly. It is a disease of both young and old. Aggressive heart disease prevention should begin in childhood, when it's easier to establish healthy habits and correct harmful ones, before the damage begins."
The unique study used ultrasound to look at the arteries of recently-transplanted hearts. By placing a miniature ultrasound device on a tube and guiding it to the heart via an artery in the transplant patient's leg, the researchers were able to use sound waves to image the heart arteries.
The study examined the heart arteries of 181 heart transplant recipients two to six weeks following transplantation. The donor hearts were from people who were free of known heart disease. Nevertheless, the researchers saw well-developed atherosclerosis in the arteries of hearts from donors in all age groups -- including teenagers. While 26 of the 36 heart donors between 41 and 50 years of age had heart disease, five of 32 donors under age 20 also showed signs of atherosclerosis, the researchers report. An analysis of risk factors -- such as age, gender, high blood pressure, smoking, and body weight index (a measure of obesity) -- showed that age was associated with the degree of atherosclerosis independently of the other risk factors.
"This study of individuals with no known heart disease demonstrates that heart disease begins at a very young age and well-developed plaque deposits are present in one in six teenagers," says the researcher.
Co-authors include Eralp Tutar, M.D.; Samir Kapadia, M.D.; Khaled M. Ziada, M.D.; Robert E. Hobbs, M.D.; Philippe L. L'Allier, M.D.; Gustavo Rincon, M.D.; Luba Platt, R.N. and Steven E. Nissen, M.D.
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