Prevention of Heart Disease Starts in Childhood

You may have heard the old adage: "An ounce of prevention is worth a pound of cure." It is sage advice when it comes to heart disease. By teaching your kids to follow a healthy lifestyle, you can help reduce their risk for heart disease later in life.

Although children and teens usually don't show the symptoms of heart disease, the silent buildup of plaque (fatty deposits) can start in childhood and can have a serious impact on their adult life.

"The kinds of heart problems which relate to the problems adults have don't really manifest themselves until [the children are] much older," says Ronald Kanter, M.D., associate professor of pediatrics, division of pediatric cardiology, at Duke University. "But the seeds of those problems are sown in childhood and adolescence."

Those "seeds" include obesity, diabetes, a sedentary lifestyle, smoking, and high blood pressure.

Fortunately, parents can influence their children's behavior by encouraging healthy eating and regular aerobic exercise, as well as discouraging smoking.

A child born today is 500 times more likely to die of acquired atherosclerosis (the formation of plaque on artery walls) than of congenital heart disease, according to Michele Mietus-Snyder, M.D., a preventive pediatric cardiologist and assistant adjunct professor at the University of California-San Francisco. "It is very important for kids to grow up with the understanding that they are in large measure responsible for their health," she says.

Healthy food, healthy hearts

A balanced diet is essential for children and adolescents. "As a matter of pediatric care, we discuss the importance of a balanced diet high in fiber and low in fat," says Dr. Kanter. It is also important for kids not to overdo snacking between meals, he adds.

The U.S. Department of Agriculture's dietary guidelines for Americans recommend a total fat intake of 25 to 35 percent for children ages 4 to 18 years. A fat intake of 30 to 35 percent of calories is recommended for children ages 2 to 3 years.

Dr. Mietus-Snyder says that USDA dietary guidelines are basically sound and heart-healthy. "If kids truly ate a varied diet that adhered to [those] guidelines, they would be much the better for it," she says.

Steer clear of fast-food restaurants with your kids. If you do buy fast food, keep an eye on serving sizes, warns Dr. Mietus-Snyder. "The trend toward super-sizing everything is resulting in super-sized American kids."

Dr. Kanter says he has noticed a gradual decline in the activity levels of the children and adolescents he treats and an increase in the prevalence of obesity. "It's a clear epidemic," he says. "There is now definite evidence that obesity is a risk factor for coronary events later in life."

You can help prevent obesity in your kids by encouraging them to be active in school and at home. Give them time to play outdoors each day. The USDA's guidelines recommend 60 minutes of moderate to vigorous activity for children most days of the week. Limit their sedentary activities: Set time limits for TV watching, computer use (other than for homework) and handheld computer games. Set a good example yourself by making exercise part of your life.

Genetics and family history—including a family history of early heart attack—can also play a role. "Obtaining a good family history is very important," says Dr. Kanter. "When we see a heavy child come into the clinic and both of his parents are obese, we know the task before us is especially difficult."

The risk factors

Risk factors in childhood and adolescence that have a direct relationship on the probability of having cardiac disease later in life include obesity, an inactive lifestyle, smoking, high blood pressure, and high cholesterol, says Dr. Kanter.

"The National Cholesterol Education Program recommends performing selective screening in children whose first- or second-degree family members have had evidence of coronary artery disease below the age of 55 or for children whose parents are known to have high cholesterol or triglyceride levels, even if they have not yet developed coronary artery problems," he says.

Where exercise is concerned, Dr. Mietus-Snyder says, it need not be complicated. "Participation in organized sports or dancing is great and should be encouraged, but lack of access to formal activities doesn't preclude exercise," she says. "A body needs simply to move."

Parents must show by example, she adds. Family activities that involve movement—such as strolls and bike rides—are better for everyone.

Smoking among teenagers is also a concern. "There is recent data that show a slight upward trend in smoking among high school kids, and that is, of course, a terrible problem," says Dr. Kanter. It is not only because of the addictive nature of tobacco, but also because smoking carries with it an extremely high likelihood of heart disease, lung disease and colon cancer.

A guide to healthy, happy children

The American Heart Association (AHA) and the USDA offer some exercise guidelines for children ages 5 and older:

• Provide at least 30 minutes of enjoyable, moderate-intensity activities every day.

• Provide a total of at least 60 minutes of vigorous physical activities most days a week to maintain heart and lung fitness.

• As an alternative to 60 minutes of activity, provide two 30-minute or three 20-minute periods of activity appropriate for the age, gender and development of your child.

• Set strict limits for TV watching, computer use and play with handheld computer games.

• Don't use food as a reward for your children's accomplishments; instead, plan a physical activity that they will enjoy.

• During the summer, sign your children up for a sports camp or other camp that focuses on physical activity as a way to keep your kids moving during the summer.

The AHA also recommends the following dietary guidelines for children ages 2 and over:

• Total fat should be no more than 30 percent of total daily calories.

• Saturated fat should be no more than 10 percent of total daily calories.

• Dietary cholesterol should be less than 300 mg per day.

• Use the "age + 5" guideline for calculating the appropriate amount of fiber. Using the formula, a 7-year-old should eat 12 grams of fiber (7+5=12). When their daily calorie intake reaches 1,500 or more, increase fiber to 25 grams.

• Children also should eat at least five servings of fruits and vegetables each day and other foods low in saturated fat and cholesterol.