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European Society of Cardiology

Clinical Articles, Lead Article

Atherosclerosis begins early in obese children

Obese children have blood vessel damage and insulin resistance that are precursors to atherosclerosis and diabetes, according to research presented recently at ESC Congress 2013 by Dr Norman Mangner. The findings highlight the need to adopt a healthy lifestyle early in life to prevent cardiovascular disease (CVD), which was the theme of World Heart Day 2013, held recently.

A World Heart Federation survey last year found that half of adults believe they should wait until age 30 or older before taking action to prevent heart disease and stroke.

Dr Mangner’s research1 discovered that obese children had early stages of atherosclerosis, as well as insulin resistance as a pre-stage to diabetes and higher systolic blood pressure. The changes were still there after two years.

Dr Mangner said: “It is worrying that young obese children already have early signs of atherosclerosis, which puts them at increased risk of developing heart disease in later life. On top of that they also show early signs of diabetes. It is crucial that children are active and eat healthily to avoid becoming obese and sentencing themselves to a life of ill-health.”

Professor Grethe Tell (ESC spokesperson)

Professor Grethe Tell (ESC spokesperson)

Other research2 followed 2,552 subjects aged 25–39 years from the Framingham study for 30 years and found that obesity in young adults increases the risk of CVD or diabetes by 23%. Nearly the same increased risk was observed in normal weight adults with CVD risk factors (hypertension or dyslipidemia). Risk of CVD and diabetes was highest (45%) in obese young adults with risk factors, and lowest (13%) in those with normal weight and no risk factors.

First author Dr Tomasz Zdrojewski (Poland) said: “Adopting a healthy lifestyle in early life is clearly essential for avoiding disease later on. It’s not just being fat that is a risk. High blood pressure and high levels of fat in the blood are also dangerous. Eating healthy food and being active are a must for children.”

Professor Grethe Tell (Norway), ESC prevention spokesperson, said: “On World Heart Day 2013 the ESC is emphasising the importance of a healthy lifestyle from a young age. One in 10 school-aged children is overweight. Bad habits have an impact on young hearts and the effects carry on until adulthood. Regular exercise and a healthy diet need to be part of daily life from childhood and it’s essential that children do not take up smoking.”

Professor Tell added: “It is alarming to see that popular belief has it that you should wait until age 30 before looking after your heart health. The reality is that only a lifetime of avoiding common risk factors can be expected to prevent heart disease in the long run. ESC guidelines recommend that prevention should start during pregnancy and last throughout life.”

Professor Tell concluded: “There is increasing evidence that unhealthy lifestyles even in very young children can increase their risk of future heart disease. Children who eat nutritious food, exercise and do not smoke are not just learning behaviours that will be important as adults, they are increasing their chances of avoiding heart disease.”

Speaking to BJC Arrhythmia Watch, Professor Tell said: “These findings lend support to the importance of primary prevention, especially with regard to the prevention of obesity. Children who are at risk of becoming obese, with its sequela, should be monitored for their weight, and if needed family counselling regarding proper diet and physical activity should be initiated.”


1. Abstract 4361: Vascular alterations and risk factor profile in pre-pubertal obese children after two years of follow up. Euro Heart J 2013;34. Abstract Supplement, 805

2. Abstract 4362: Obesity confers similar 30-year risk of cardiovascular or diabetes as hypertension or hypercholesterolemia in young adults. Euro Heart J 2013;34. Abstract Supplement, 805

Published on: October 30, 2013

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