Yes! We have reduced the incidence of heart attack and stroke by over 30% in the last 30 years….50% of that being due to better medical care ….the other 50% was in reducing risk factors in individuals who already had the disease. Yet, one in four men and women in North America over the age of 35 still die from Atherosclerotic; hardened arteries, heart disease and stroke. And those who do not die, one in two will suffer disability as a result of CAD. Eradicating this disease would save $20 billion in Canada and $300 billion in the USA in health care costs, would improve our economics and build thriving communities.
The reason it is not being eradicated is because we are targeting the wrong people. Atherosclerotic hardening of the arteries, or Arteriosclerosis Heart Disease (ASHD), begins in childhood.
Yes! The disease that causes a heart attack or Coronary Artery Disease, (CAD), in a person’s 40s and 50s began in that individual before they were 10 years old. In many cases the damage done to the hearts’ artery walls before the age of 25 is irreversible and in some cases no what changes are made a future heart attack is just waiting to happen. Many studies: Bogalusa, Muscatine, PDAY, Turku have confirmed that unless the conditions causing artery wall damage are addressed in adolescence men will have irreversible disease by 25 years of age and women by 35 years of age. That is why so many adults in their 40s and 50s who have heart attacks cannot understand why as they have led exemplary lifestyles for the past 20 years. But by then it was too late. And tragically 50% of those premature heart attacks will be fatal. The US National Heart, Lung and Blood Institute, (NHLBI), has even issued a set of guidelines to identify children, and their families, at high-risk. The decrease in incidence from the mid-1980s up to now has started to flatten out, probably due to increasing obesity, with its accompanying diabetes, and inactivity in the whole population. The lifetime risk of CAD with 2 positive CVD Risk Factors for American males is 37.5 %, (more than 1 in 3). In American females with 2 positive Risk Factors it is 18.3%.
There is irrefutable evidence to prove that eradication of ASHD/CAD can only be achieved by targeting young people.
Risk factor modification of this disease is only effective if initiated in adolescence before the disease has progressed. Previous arguments against identifying young individuals at High-Risk of CAD because it is too upsetting for youth are ridiculous when set against the data which show this to be the only time intervention can be successful in risk reduction. And the only time they can be advised on how to avoid an otherwise inevitable heart dysfunction. Similarly the argument that such information creates ‘labeling’ has never been confirmed by any reputable study. We tell young people if they have diabetes. We inform young people if they have heart murmurs. But we are not to tell them that they carry an increased risk of a heart attack in the next 20 years. We are not to tell them of the risk of a Family History of heart disease or diabetes. We are not to tell them they are obese. We are not to tell them they have high Blood Cholesterol. We are not to tell them they have high Blood Pressure. Even though we know that all these factors will not change as they grow older: they will track into adulthood unless they are addressed now. Yet, we have reduced the incidence of heart attack by 30% partly due to identifying and treating those adults who have the disease.
At Heart Niagara our Niagara Healthy Heart Schools Program, provides students and their families those same benefits and opportunities by interacting with students and families on the issue of CAD. Available to all Niagara High Schools region wide, Heart Niagara transforms the gymnasium into a clinic. Students receive their CAD risk based on their bio metric measurements (family history, smoking behaviours, height, weight, waist circumference, blood pressure and cholesterol). The findings from the program have shown that 43% of Grade 9 adolescents have at least 1 positive Risk Factor and 12% already had 2 positive risk factors at just 13-15 years of age. Even worse about that statistic is that one of the Parents of the adolescent with 2 risk factors has 2 or possibly more risk factors at a much more critical stage of their life while being totally unaware of their risk. Families who have an adolescent with a risk score are more likely to have the adults screened than families who do not know their risk at all.
The Niagara Healthy Heart Schools Program is an example of whole population CAD intervention, modification and promotion of awareness for adolescents. The program allows adolescents and families to have a picture of their risk before it becomes fatal or debilitating. Seeing adolescents prior to irreversible damage is essential in reducing and eliminating CAD, a disease that claims the lives of far too many individuals each year.
To stop hardening our hearts, we need to start where the disease begins, during adolescence. We need to go where we can provide all adolescents the same benefits and opportunities. Schools are the only place where we can see the whole adolescent population.
Tomorrow I’ll talk about the pathway to CAD, the arteries.
Dr. Stafford W. Dobbin, Heart Niagara Founder, Healthy Heart Schools’ Program Medical Director