Children and Heart Disease: What's Wrong With This Picture?

As more children become obese, pediatric heart disease is becoming more common.

From the WebMD Archives

Few parents expect their children to develop heart disease. So when her daughter Alex started gaining weight at age 7, Tammy Benton was concerned -- but not overly concerned. Working with a pediatrician, she tried to encourage Alex to eat more healthfully.

"I didn't talk 'diet' to her," recalls Benton, 46, of Essexville, Mich. Instead, she pointed her daughter to better choices such as fruit instead of candy. Alex did lose some weight but eventually gained it back. By the time she was 14, she weighed 320 pounds. This time, Benton and her daughter had a serious discussion with their pediatrician, who referred them to heart specialists.

Benton, who takes cholesterol-lowering medications, was worried not only about Alex's weight but also with how her own history of high cholesterol would affect both her daughters. Alex, now 19, and Benton's other daughter, Sidney, now 17, have had high cholesterol since they were 8 years old. By age 12, Alex needed medication to lower her cholesterol.

Even so, Benton wasn't prepared for what the heart doctors had to say. "They talked about Alex's increased risk factors [for heart disease] and her chances of heart attack and stroke." And they weren't referring to her future risk as an adult -- but to her immediate risk. "Keep in mind Alex was 14 years old. When they start talking to you about your child having a heart attack or stroke, it's horrifying," she says.

The Childhood Obesity Epidemic

Like Benton, most parents are surprised at the gravity of the risks associated with childhood obesity -- and that the risks are immediate, not down the road in adulthood, says Thomas Kimball, MD, a pediatric cardiologist at Cincinnati Children's Hospital Medical Center and professor of pediatrics at the University of Cincinnati College of Medicine.

But unfortunately, the statistics tell the sober truth: Childhood obesity has skyrocketed in the past three decades, according to the CDC. Stats for 1976–1980 show that 6.5% of children ages 6 to 11 were obese; by 2003-2006, that number had jumped to 17%. Similarly, only 5% of preteens and teens ages 12 to 19 were obese in 1976–1980; but 17.6% of this age group were found to be obese in 2003-2006. ("Obese" is defined as having a body mass index above the 95th percentile compared with other children of the same age and gender.)

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Obesity, in turn, is triggering a host of other heart disease risk factors in children, such as type 2 diabetes, high blood pressure, and high cholesterol -- considered "adult" health problems until recently. The result? A higher risk of heart disease and stroke at young ages, Kimball says. "We're seeing changes in heart structure and artery structure [in kids] that we normally don't see until well into adulthood," Kimball says.

The cholesterol problem among children and teens has gotten so bad that some doctors are prescribing cholesterol-lowering statins (such as Lipitor) for children, although the practice is controversial. "It's still pretty rare, but it is happening," Kimball says.

Solutions to Childhood Obesity

Experts agree the obvious and urgent starting point is weight loss. Once weight is reduced to a healthy level, some of the other risk factors take care of themselves. And even children with greatly increased heart disease risks might be able to turn things around.

Alex did. She and her doctors decided on gastric bypass surgery -- not a panacea, Kimball emphasizes, but a wise treatment for carefully selected patients. While waiting for the operation, Alex exercised more. Walking was her main form of exercise. She also played golf, biked, and swam when she could. She followed a diet that emphasized plenty of protein but much less fat, and she measured servings so portion sizes were reasonable. She lost about 20 pounds and remained on statin drugs to lower her cholesterol, then had the surgery when she was 15.

Three years later, Alex's weight has decreased, and she is losing more weight by continuing to follow the high-protein, low-fat diet. She is down to 240 pounds and still working at it. Her goal is a BMI below 25 -- considered a healthy level. For her, that's about 143 pounds. And she not only has reduced her risk of having a heart attack or stroke but also has reclaimed her life. "She's an active 19-year-old, in college and working full time. She is an avid golfer now and played softball her senior year of high school. She's keeping up with everyone. She's in a whole new realm of life," Benton says.

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Questions to Ask Your Doctor About Childhood Heart Disease

Worried about your child's risk for getting heart disease? Here are some questions you can ask your pediatrician:

Is my child's weight healthy?

"We've lost track of what is normal weight," says Kimball. Your child's BMI should be calculated beginning at age 2, according to the American Academy of Pediatrics. A healthy weight is between the fifth percentile and the 85th percentile, depending on age and sex.

Should my child's cholesterol levels be checked?

According to the American Academy of Pediatrics, children with a family history of high cholesterol or heart disease, children with risk factors such as obesity or diabetes, and children whose family history is unknown should all be screened for high cholesterol. Screening should be done after age 2 but before age 10.

What is my child's blood pressure?

This is especially important to know, Kimball says, if your child is overweight. "Obesity begets hypertension," he says.

Should I test my child for diabetes?

An overweight child is at risk for type 2 diabetes, which, left untreated, can lead to multiple health problems, including heart disease.

WebMD Magazine - Feature Reviewed by Brunilda Nazario, MD on 2/, 009

Sources

SOURCES:

Tammy Benton, Essexville, Mich.

Thomas R. Kimball, MD, pediatric cardiologist, Cincinnati Children's Hospital Medical  Center;  professor, pediatrics, University of Cincinnati College of Medicine, Ohio.

American Academy of Pediatrics: "Prevention of Pediatric Overweight and Obesity."

CDC: "Childhood Overweight and Obesity."

CDC: "About BMI for Children and Teens."

American Academy of Pediatrics: "New AAP Policy on Lipid Screening and Heart Health in Children."

Morrison, J. Journal of Pediatrics, February 2008; vol 152: pp 201-206.

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