By Ed Edelson, HealthDay Reporter
The path to heart disease begins in childhood, and that means preventive measures must be embraced by those at risk long before adulthood, researchers report.
Two of the biggest threats to heart health that trace back to childhood are prehypertension -- blood pressure just below the official high blood pressure reading of 140/90 -- and obesity.
"The message of the Bogalusa Heart Study is that coronary artery disease, atherosclerosis, hypertension and heart disease all begin in childhood," said study director Dr. Gerald Berenson, a professor of cardiology at the Tulane Center for Cardiovascular Health, in New Orleans.
Berenson was to present the findings Wednesday at the American Society of Hypertension annual meeting, in New Orleans.
The goal of the Bogalusa (Louisiana) Heart Study is to tease out the early natural history of cardiovascular disease. It's the longest and most detailed study of a biracial population of children and young adults in the world.
One aspect of the study was to evaluate the importance and impact of prehypertension, a term Berenson dislikes because "it may give somebody an idea that they don't have a disease and don't need to be treated for it. It should not be looked on as innocuous."
Indeed, people in the study with prehypertension had more risk factors for cardiovascular disease, including obesity, high levels of blood fats such as cholesterol, and diabetes.
A report on a group of 1,379 young adults in the study showed that 27 percent of them had prehypertension, while 13 percent had true high blood pressure. There were significant gender and racial differences, with prehypertension found in 35 percent of the men compared with 22 percent of the women. Black males were more likely to have high blood pressure -- 28 percent -- than while males, 12 percent.
"One of the unique things about this study is that it has a black and a white population," Berenson said. "Blacks tend to have more high blood pressure and diabetes, while whites have more coronary artery disease at an early age."
A second report on 824 young adults in the study (average age 36) concerned potentially dangerous changes in heart structure over time, such as left ventricular hypertrophy, or overgrowth of one heart chamber. "The heart starts to get big, dilated," Berenson said. "It also becomes concentric, and the muscle walls are thick."
Such cardiac abnormalities were more common in adults who had diabetes and high blood pressure in childhood. But the major cause was obesity, Berenson said.
"Obesity in childhood is the only consistent factor predicting cardiac enlargement in adults," he said. "It also predicts adult vascular stiffness." That is a formal medical term for what most people call hardening of the arteries.
"These observations give a compelling reason for pursuing preventive, personalized intervention strategies at an early age in order to evaluate obesity and underlying cardiovascular disease risk factors," Berenson said in a statement.
Dr. Keith Ferdinand, a clinical professor of medicine at Emory University and a board member of the American Society of Hypertension, called the new findings important because they show that "heart disease and hypertension start early in life, in adolescence and even in the pre-teen years."
"In clinical medicine, we focus on patients who have documented heart disease and left ventricular hypertrophy," Ferdinand said. "Based on this new research, which confirms prior findings, in order to decrease the rates of hypertension and heart disease, we should target our young people."
The racial disparities seen in the study "are probably due to early and younger exposure to an adverse lifestyles, including less intake of fruits and vegetables and high intake of salty foods," he said.
Learn more about prehypertension from the U.S. National Heart, Lung, and Blood Institute.
SOURCES: Gerald Berenson, M.D., professor, cardiology, Tulane Center for Cardiovascular Health, New Orleans; Keith Ferdinand, M.D., clinical professor, medicine, Emory University, Atlanta; May 14, 2008, presentation, American Society of Hypertension annual meeting, New Orleans