Adolescents and Heart Disease

It can happen suddenly. One day a parent suddenly suffers a heart attack or undergoes bypass surgery for coronary heart disease at a relatively young age - before reaching 55. Is there anything the child can do to avoid a similar fate, or is it all simply genetic?

According to a new study appearing in Circulation, adolescent boys who have at least one parent with early signs of coronary heart disease are much more likely to exhibit several early warning markers of the disease, even before they're teenagers.

In a case-control analysis, cardiologists from the Cincinnati Children's Hospital Medical Center found that these boys, aged 10-15, already had higher levels of homocysteine, an amino acid associated with damage to the vascular endothelium. Elevated levels of this marker were independently associated with a 2.6-fold increased risk of early coronary heart disease in the family. Lipid abnormalities, specifically higher LDL cholesterol and lower HDL cholesterol, were also reported more frequently in these boys compared to their peers without family history.

The researchers focused particular attention on the potentially damaging role of oxidative stress in early coronary disease. Decreased levels of serum glutathione in these children and adolescents translated into less protection against free radical activity, and a resulting 60% increased incidence of parental coronary heart disease, independent of other factors.

"Oxidative stress may be important in the development of coronary artery disease," investigators emphasised, "because the heart, in contrast to the liver or lung, is relatively poorly defended against oxidative stress."

Noting that classic risk factors still "account for only half of the morbidity and mortality from coronary heart disease," researchers called these new biomarkers "clinically important" for children and adolescents with a higher risk of coronary heart disease. Levels of these markers, they noted, can often be modified through dietary and lifestyle interventions.

NOTE: Starting in adolescence, any individual with a family history of heart disease may wish to undergo a thorough work-up to evaluate the hidden, synergistic mechanisms that can generate and propel the degenerative process of cardiovascular disease (CVD). It can do no harm to supplement with anti-oxidants, particularly in Hong Kong where the food is depleted. The most important anti-oxidants are Vitamin E, Vitamin C and selenium.