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September 14, 2000
News this month It appears even young men do not escape the wrath of the long-term effects of high cholesterol and clogged arteries. Two recent studies indicate men as young as 18 have high cholesterol, which put them at high risk for heart disease, and boys as young as 15 have advanced arterial blockage. …2% of the 15- to 19-year-old boys
and 20% of men ages 20 to 34 in their sampling had advanced arterial
blockage…
AHA journal study finds plaque in boys Dr. Henry McGill, Jr. of the Southwest Foundation for Biomedical Research in San Antonio led a group of researchers who examined the autopsies of 760 young men and women, ages 15-34, who had died in accidents, homicides and suicides. McGill and his colleagues studied portions of their left coronary arteries, one of the pair of large blood vessels that supply blood to the heart. They measured the amount and type of fatty deposits in the arteries and assessed other risk factors such as smoking, high blood pressure, obesity and high cholesterol. Subjects who had high levels of…"bad"
cholesterol, were about two-and-a-half times more likely to have
advanced plaque blockages in their coronary arteries…
Subjects who had high levels of LDL, so-called "bad" cholesterol, were about two-and-a-half times more likely to have advanced plaque blockages in their coronary arteries than those who did not. The young people who were obese were also two-and-a-half times more likely to have advanced plaque. Advanced plaque is defined as deposits on blood vessel walls with a fibrous coating and a soft fatty core. They are considered at high risk of rupturing and forming blood clots, which could result in a heart attack or sudden death. Healthy habits must begin early "Finding dangerous advanced plaque in teenagers and young adults tells us if we are to reduce heart attacks and deaths due to coronary heart disease, we need to make sure our children are eating healthy foods, exercising and not smoking," said Dr. Arthur Zieske, a pathologist at Louisiana State University who worked on the study. …young men with high cholesterol
face a greater long-term risk than men who develop the condition
in middle age.
JAMA study Researchers led by Dr. Jeremiah Stamler, professor of preventive medicine at Northwestern University Medical School, evaluated data from three large studies involving men with no history of diabetes or heart attacks. The studies followed nearly 82,000 men, ages 19 to 39, for up to 34 years. Researchers found death due to heart disease accounted for one-fourth to one-third of all deaths among the men in all three studies. Men were at greater risk for heart disease-related death if their total cholesterol at the outset of the study was above 200. Those with levels above 240 at an early age had 2.2 times to 3.6 times greater risk than those whose levels were below 200. In contrast, men with normal cholesterol levels had life expectancies that were longer by four to nine years. …the findings indicate it’s
never too early to start watching your cholesterol.
In an accompanying editorial, Dr. Scott M. Grundy of the University
of Texas Southwestern Medical Center in Dallas says the findings
indicate it’s never too early to start watching your cholesterol.
"The current evidence supports recommendations for measurement
of cholesterol levels in adults ages 20 years or older at least
every five years.'' 
Physician Referral Online A free and confidential service Physician Referral Online Request an appointment 203-688-2000
 Yale-New Haven was recognized this year by U.S. News & World Report for its programs in cardiology and cardiac surgery. |
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Early screening important for long-term prevention Although it may be surprising to see even a moderate amount of heart disease in young Americans, this study published in Circulation underscores the need to screen and treat young patients for heart disease, particularly if several risk factors are present. "A diet high in fat, a sedentary
lifestyle and tobacco smoking can multiply the odds of young men
developing heart disease from ages as young as 15…"
A diet high in fat, a sedentary lifestyle and tobacco smoking can multiply the odds of young men developing heart disease from ages as young as 15, according to this study. Although they may not experience any of the symptoms of heart disease at this age, the disease progresses until middle age when they are at high risk of dying from heart disease-related illnesses. The 760 autopsied 15-34 year olds in this sample may not be totally representative of the population. Their deaths were the result of accidents, homicides or suicides; and there may be lifestyle issues that put them at higher risk than the general population for heart disease as well as for traumatic deaths. Even if they are not perfectly representative, however, the 20 percent incidence of advanced coronary artery narrowing among men in their early 30s is surprisingly high. Plaque grading system Incidence varies with age, sex and risk factors The researchers also determined that 3.2 percent of the males in the 15- to 19-year-old group had arteriosclerosis, which they defined as a narrowing in the coronary arteries of 40 percent or more. This prevalence increased with age to almost 19 percent among the 30- to 34-year-old men. None of the younger women had arteriosclerosis. "The most severe [plaque] lesions
were most closely associated with obesity, high "bad"
cholesterol and high blood pressure."
The researchers compared various risk factors for heart disease with the incidence of plaque. In this sample, only 22.4 percent of the young adults had no risk factors. The most severe lesions were most closely associated with obesity, high "bad" cholesterol and high blood pressure. Smoking was more closely associated with level 2 and 3 lesions. The study infers the effects of smoking take years to develop and may not be apparent as early as cholesterol, obesity and hypertension. Cholesterol and later mortality "There is a direct relationship
between high cholesterol in young adulthood and the risk of dying
from heart disease decades later."
The study controlled for other risk factors such as smoking and high blood pressure, so the results apply to the effect of cholesterol on longevity only. The long follow-up period is important since the longer people are studied, the more reliable the data. The message is straightforward. There is a direct relationship between high cholesterol in young adulthood and the risk of dying from heart disease decades later. The higher the cholesterol reading when the subjects entered the study, the higher their risk of dying from heart disease in middle age. Men who had cholesterol readings of 200 or lower when they began the study enjoyed a 3.8 to 8.7 years longer life expectancy than those with levels of 240 or higher. Early screening and behavior modification key "We work with [young] patients
with LDL levels of 160 or greater by lowering the fat in their
diets and increasing exercise."
I seldom treat young adults with cholesterol-lowering medications because we have no data on the effects of taking these medications for several decades. We work with patients with LDL levels of 160 or greater by lowering the fat in their diets and increasing exercise. Children under the age of 24 months should not be put on very low fat diets since their bodies need moderate levels of fat for brain development. About 50 percent of the daily calories in diets of children under the age of two should come from fat. After age two, dietary fat can safely be reduced to 30 percent of daily calories. My advice to parents is do what you can to set a good example
and establish healthy habits when your kids are young. It’s
easier to grow up with healthy eating habits than to change them
when you get older. Encourage your family to eat more fruit and
vegetables and choose chicken and fish over red meat. Dr. Freed is a cardiologist and an associate with The Cardiology Group with offices in New Haven and Branford. She is an attending physician at Yale-New Haven Hospital and Yale-New Haven Heart Center. |
