Early Childhood Screening for Heart Disease Urged
MONTEREY, Calif. — The harbingers of adult heart disease can be detected in early childhood, according to a prominent heart disease researcher who called Tuesday for routine cholesterol and blood pressure screening for all children upon entering school or sooner.
Dr. Gerald Berenson, chief of cardiology at Louisiana State University Medical Center and head of an ongoing, 15-year study of 10,000 children and young adults in Bogalusa, La., said tendencies toward high blood-cholesterol levels can be seen in blood tests at ages as early as 6 months. Tendencies toward persistent high blood pressure, he said, are detectable among 8- to 10-year-olds.
“Coronary heart disease and hypertension very clearly begin in childhood . . . and atherosclerosis clearly begins even in infancy,” Berenson said at an American Heart Assn. forum here. “I think kids are being neglected in education and in health care.”
Berenson’s recommendations conflict with those of the American Academy of Pediatrics, which recently advised screening only for children with a family history of cardiovascular disease. Academy officials say they are concerned that restricted diets might cause unanticipated nutritional problems in growing children.
Dr. Laurence Finberg, chairman of the academy’s committee on nutrition, said in an interview Tuesday that there is no proof that steps taken in childhood will prevent adult heart disease. While it is accepted that antecedents of heart diseases surface early in life, he said, those trends can be reversed in adulthood through diet, life style and medication.
“You might do good for heart disease but bad for something else,” Finberg said of significantly limiting a child’s diet. As an example, he said restricting fat intake might cut a child’s energy and prevent him or her from achieving full growth.
Berenson based his recommendations on his study of children and young adults in Bogalusa, where he said detailed physical examinations, as well as autopsies of young people who had died before age 26, indicate that cardiovascular disease is rooted, and might be prevented, in childhood.
The most striking evidence includes so-called fatty streak lesions found on the surface of the aorta in many of the 117 children and young adults who died, Berenson said. Those fatty deposits, traceable to elevated cholesterol, are believed by some to be precursors of the plaques that can eventually block arteries and cause severe damage to the heart.
According to Berenson, the lesions he found in autopsies correlated closely with high blood cholesterol levels measured in examinations while the children were alive. The researchers also found more advanced lesions in the coronary arteries of nine of 34 boys and young men, but only in one of 11 women examined both before and after death.
“The autopsy findings give credibility to doing risk factor examinations in children,” Berenson said. He claimed that it would be possible to identify 60% to 70% of the children who are destined to develop heart disease as adults.
Such screening should include examinations of each child’s height and weight, body fat, blood cholesterol levels, blood pressure and family history of cardiovascular disease--all indicators of heart disease risk, according to work by Berenson and others.
Berenson said it should be possible to predict cholesterol problems at 6 months of age and persistent high blood pressure at ages 8 to 10. He said levels of apparently beneficial high-density lipoprotein (HDL) cholesterol could be predicted in adolescence.
While Berenson said he would recommend dietary restrictions for children, he advised against tampering with the diets of those under 2 years old. He said there is too much uncertainty about the risks of interfering in a critical stage of development.
Officials of the pediatrics academy expressed another reservation Tuesday about Berenson’s call for universal childhood screening: They said some testing techniques used in doctors’ offices are imprecise and could result in children being wrongly branded as requiring special attention and a restricted diet.
As an example, a spokeswoman for the academy said, finger-prick blood tests can give a high cholesterol reading based simply upon what the person being tested just ate. She said a child with such a result might unnecessarily be placed on a limited diet--denied, for example, birthday cake.
