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Pediatricians can help prevent the start of chronic heart disease, says Stanford doc

When does chronic cardiovascular disease get its start? According to a growing body of evidence, risk for dangerously thickened arteries can often be traced back to high levels of childhood stress.

In a new review article in Mayo Clinic Proceedings, Stanford general pediatrics expert Donald Barr, MD, summarizes what pediatricians should know about the connection. If kids' doctors understand how the link works -- as well as what sources of stress to look for and how to help connect families to the resources to alleviate that stress -- it could benefit children in the short run and also protect their hearts as they grow into adulthood.

Chronically high levels of the stress hormone cortisol cause chronic inflammation that can, in turn, lead to thickening of the arteries, the review article explains. Elevated cortisol levels don't affect all segments of the population equally, and neither does cardiovascular disease; instead, both are more common in people living in poverty, as well as members of some racial and ethnic minority groups.

And early-life poverty has a sustained effect. One of the most interesting studies demonstrating this (of several that Barr describes) was performed in 103 healthy young adults in Vancouver, Canada, all of whom had the same socioeconomic status and similar levels of health behaviors at the time that the study was done. But before age 5, half had lived in poverty, while the other half were raised in families that had plenty. In the group with a history of poverty, cortisol levels and levels of some inflammatory markers were still higher -- decades after their early childhood experience.

To try to help alleviate stress in young patients, pediatricians can become familiar with recent professional guidelines on how to look for stress in children, as well as by strengthening their ties to social service and preschool agencies that can help needy families, Barr writes. He concludes:

'The evidence is clear and consistent that chronically elevated cortisol levels among children growing up in adversity develop early in childhood, and are readily apparent by adolescence... Physicians other health care providers must be concerned that, independent of subsequent behavioral patterns, children experiencing high levels of adversity during childhood may be on a road to early cardiovascular disease.'

Previously: Can social media shed light on cardiovascular disease? Possibly, Stanford journal editors write, Cardiovascular disease burden traced to race and geography and The link between mental-health conditions and cardiovascular disease
Photo by Danielle Elder

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