A landmark paper in 1953 radically changed our view about the development of heart disease forever. The study looked at a series of 300 autopsies performed on U.S. battle casualties of the Korean War. The average age was 22 years old, but 77% of the soldiers' hearts had gross evidence--meaning visible-to-the-eye evidence--of coronary atherosclerosis, hardening of their arteries. Some of them had vessels that were clogged off 90% or more. As an editorial in the Journal of the American Medical Association concluded, "This widely cited publication dramatically showed that atherosclerotic changes appear in the coronary arteries years and decades before the age at which coronary heart disease (CHD) becomes a clinically recognized problem." Follow-up studies on the hearts of thousands of more soldiers over the subsequent years confirmed their results.
How young does it go? Fatty streaks, the first stage of atherosclerosis, were found in the arteries of 100% of kids by age ten. What's accounting for this buildup of plaque even in childhood? In the '80s we got our first clue in the famous Bogalusa Heart Study. This looked at autopsies of those who died between the ages of 3 to 26 years old, and the #1 risk factor was cholesterol intake. There was a dramatic stepwise increase in the proportion of their arteries covered in fatty streaks as the level of bad cholesterol in the blood increased. As powerful as this was, the study only looked at 30 kids. So they decided to study 3000: three thousand accidental death victims, ages 15 through 34.
After thousands of autopsies, they were able to produce a scoring system that could predict the presence of advanced atherosclerotic lesions in the coronary arteries of young people. The higher our score, the higher the likelihood we have these lesions growing in the arteries that pump blood and oxygen to our heart. So if we're young and we smoke, our risk goes up by one point. If we have high blood pressure at such a young age, that's four points. If we're an obese male, that's six points, but high cholesterol was the worst of all. If our non-HDL cholesterol (meaning the total cholesterol minus the good cholesterol) is above 220 or so, our risk increased eight times more than if we smoked.
Let's say you're a woman with relatively high cholesterol, but you don't smoke, you're not overweight, your blood pressure and blood sugars are OK. At your sweet 16 there's just about a 1 in 30 (3%) chance you already have an advanced atherosclerotic lesion in your heart, but if you don't improve your diet, by your 30th birthday, it's closer to a one in five (20%) chance you have some serious heart disease, and if you have really high cholesterol it could be closer to one in three (33%).
In the video, Heart Disease Starts in Childhood, you can see what happens to our risk if we bring our cholesterol down to even just that of a lacto-ovo vegetarian, or if we exercise to boost our HDL, etc. It shows that even in 15 to 19-year-olds, atherosclerosis has begun in a substantial number of individuals, and this observation suggests beginning primary prevention at least by the late teenage years to ameliorate every stage of atherosclerosis and to prevent or retard progression to more advanced lesions.
If we start kids out on a low saturated fat diet, we may see a significant improvement in their arterial function by 11 years old. The study concluded, "Exposure to high serum cholesterol concentration even in childhood may accelerate the development of atherosclerosis. Consequently the long-term prevention of atherosclerosis might be most effective when initiated early in life." And by early in life they meant infancy.
Atherosclerosis, hardening of the arteries, begins in childhood. By age ten nearly all kids have fatty streaks, the first stage of the disease. Then the plaques start forming in our 20s, get worse in our 30s, and can start killing us off in middle age. In our hearts it's a heart attack, in our brains it's a stroke, in our extremities it can mean gangrene, and in our aorta, an aneurism.
For those of us older than ten years of age, the choice likely isn't whether or not to eat healthy to prevent heart disease, it's whether or not we want to reverse the heart disease we likely already have.
Drs. Dean Ornish and Caldwell Esselstyn Jr. proved that we can reverse heart disease with a plant-based diet, but we don't have to wait until our first heart attack to start unclogging our arteries. We can start reversing our heart disease right now. We can start reversing heart disease in our kids tonight.
The bottom line is that we have tremendous control over our medical destinies. How do we go about reversing our heart disease? I address that question in my latest live annual review presentation More Than an Apple a Day. Or, for shorter snippets:
- Resuscitating Medicare
- Eliminating the #1 Cause of Death
- China Study on Sudden Cardiac Death
- Our Number One Killer Can Be Stopped
- Heart Attacks and Cholesterol: Purely a Question of Diet
- Trans Fat, Saturated Fat, and Cholesterol: Tolerable Upper Intake of Zero
Heart disease is a choice.
-Michael Greger, M.D.
Image Credit: James MacDonald / Flickr