Teens and Heart Disease. Suzie Mookherjee, MD FACC Assistant Professor of Medicine Division of Cardiology

Transcription

1 Teens and Heart Disease Suzie Mookherjee, MD FACC Assistant Professor of Medicine Division of Cardiology

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3 Why Should Teens be Concerned About Heart Disease? Heart disease is the #1 cause of death in men and women Adult problem, but the process begins early in life and is progressive 1/3 of teens between the age of 10 and 19 have cholesterol levels that are too high

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7 Atherosclerosis Begins in childhood and is progressive Genetics, diet, physical activity OBESITY EPIDEMIC Autopsy studies: early sign: fatty streak fibrous plaque Heart attack, stroke Bogalusa Heart Study 70% of kids had fatty streaks and fibrous plaques

8 Atherosclerosis High blood pressure Obesity Total cholesterol: high LDL, low HDL, TG Lipid Research Clinic: The concentration of serum lipids increases during early childhood; similar to that of young adults by 2 years of age!!

9 High Cholesterol 13.3% of 4 th graders: >200 mg/dl 10% of adolescents had total chol >200 mg/dl Over time, the numbers don t change

10 High Cholesterol 25% of pediatric population Total chol: >170 HDL < 40 male, 50 female LDL >170 TG > % persistent dyslipidemia into adolescence and early adulthood AHA 2006; AFP 2008

11 Cut Points for Total Cholesterol and LDL Concentrations in Children and Adolescents Category Percentile Total Cholesterol, mg/dl LDL, mg/dl Acceptable <75th <170 <110 Borderline 75th 95th Elevated >95th >200 >130

12 High Cholesterol

13 AAP Recommendations Healthful diet all children > 2yrs of age 12-months -2 years: low fat milk Obese or +family history Screen: after 2 years of age: no later than 10 years +FH of high chol or premature heart disease FH unknown Overweight/obese, high BP, smoker, diabetes Every 3-5 years if normal Weight management pediatrics/.aappublications.org

14 Body Mass Index Body mass index (BMI) is a statistical measure of body weight based on a person's weight and height. Though it does not actually measure the percentage of body fat, it is used to estimate a healthy body weight based on a person's height.

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17 Body Mass Index (NEJM April 2011) Risk of coronary disease is associated with an elevated BMI both in adolescence and in adulthood Norwegian Health Survey 3X higher risk of angiographic proven CAD in adolescent boys with high BMI

18 High Blood Pressure Associated with Obesity Direct correlation with TV time 2-4 hrs/day: 2.5X the risk >4 hrs/day: 3.3X the risk LV Hypertrophy (40%): thicker heart Diet can help Fruit,veggies,dairy

19 Type II Diabetes 1:1000 overweight teenagers Screen: BMI>85% starting at age 10 or onset of puberty Plus 2: FH of DM 1 st or 2 nd degree relative AA, Hispanic, American Indian, Asian, Pacific Islander Signs of insulin resistance Skin, high bp, chol, gynecological

20 Metabolic Syndrome in Teens 4-7% of American teens have metabolic syndrome 30% of significantly overweight teens have metabolic syndrome, characterized by: Elevated blood pressure High triglycerides Excess abdominal fat Elevated blood glucose -- All teens -- Low HDL cholesterol Arch Pediatric & Adolescent Med, Aug. 2003

21 Metabolic Syndrome Metabolic syndrome increases the risk for: heart disease diabetes This condition is corrected by getting regular aerobic activity achieving a healthy weight Arch Pediatric & Adolescent Med, Aug. 2003

22 Metabolic Syndrome Prevalent in overweight children and adolescents Increased prevalence of obesity and diabetes Associated with increased risk of fatty streaks and fibrous plaques

23 Metabolic Syndrome

24 Exercise 60 minutes of moderate to vigorous play or physical activity Walking, biking, taking stairs No more than 2 hours of TV, video games and computer a day 79% 9 th graders/ 36% of 12 th graders Wii: does not meet exercise standards slightly better than X-Box

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27 Sudden Cardiac Death Nontraumatic, nonviolent, unexpected event resulting from sudden cardiac arrest within 6 hours of a previously witnessed normal state of health. Rare: cases annually in the US 1:250,000 More common in males, AA, football/basketball 90% structural abnormalities;10% electrical disorders

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30 History is Most Important Chest pain/discomfort Passing out (or nearly):syncope History of heart murmur Increased systemic BP Family history of early death (<50yrs) or significant disability from heart disease Specific knowledge of certain conditions

31 SCD Guidelines Parents need to complete the history form with their child Echocardiography/EKG are NOT recommended as part of routine screening Low frequency of disorders High false + $$$$$ Genetic testing in the future? Referral to cardiologist if suspicious AAP/Sports Medicine/Fitness

32 Suggested life expectancy of children will drop by 2-5 years over the next 50 years based on current trends!!! NEJM 2005

33 Obesity is the terror within Richard Carmona-Surgeon General 2006

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