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 soldiersí hearts had gross evidenceómeaning visible-to-the-eye evidenceóof 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 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 10. What’s accounting for this buildup of plaque even in childhood? In the Ď80s 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 year-olds, 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 your score, the higher the likelihood you have these lesions growing in the arteries that pump blood and oxygen to your heart. So if you’re in you’re young and you smoke, your risk goes up by one point. If you have high blood pressure at such a young age, that’s 4 points. If you’re an obese male, thatís 6 points, but high cholesterol was the worst of all. If your non-HDL cholesterol (meaning your total cholesterol minus your good cholesterol) is above 220 or so, your risk increased 8 times more than if you 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, itís closer to a 1 in 5 (20%) chance you have some serious heart disease, and if you have really high cholesterol it could be closer to 1 in 3 (33%).
If you look at the above video you can see what happens to our risk if we bring our cholesterol down to even just that of a lacto-ovo vegetarian, what happens if we exercise to boost our HDL, etc. So what this shows us is 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.Ē And by early in life they meant infancy.
Atherosclerosis, hardening of the arteries, begins in childhood. By age 10 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. If you are older than 10 years of age, the choice likely isn’t whether or not to eat healthy to prevent heart disease, it’s whether or not you want to reverse the heart disease you likely already have.
Drs. Dean Ornish and Caldwell Esselstyn 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 reverse the clogging of 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.