Tender Is The Heart
Disease and Children
Charles R. Attwood, M.D., F.A.A.P.
he little girl with the long blond ponytail would have been 55 years old today. But there she was, on my autopsy table in 1952. The end had come suddenly and unexpectedly, from bacterial meningitis. It was my first autopsy as a medical student, and I was nervous to say the least, with with the professor and my fellow students looking over my shoulder. I was especially shaken, since she had also been my "patient" a short time before.
Finally, after three tedious hours, I held her heart in my hand for a moment before beginning to open it. There, I saw, near the origin of her left anterior descending coronary, a visible yellow streak in the interior wall of the artery.
"That's cholesterol," said the professor, as he gathered the other students about me. "Look carefully, because you'll probably never see this again in a child." The fixed specimen was later added to the school's collection of medical rarities.
At that same time, unknown to all of us, autopsies were finding far greater deposits of fat in the arteries of the majority of American soldiers killed in Korea. Their average age was 21. Reports appeared in a major medical journal, but were largely ignored by practicing physicians. When the same findings were reported 15 years later, during the Vietnam War, again, it was hardly noticed. Here, their Asian counterparts were examined and found to have clean arteries.
In 1972 a 25 year study began in Bogalusa, Louisiana, whereby children were examined each year. Records were made of their weights, the eating habits, cholesterol levels, blood pressure; and over the years autopsies were done on those who died accidentally. Here is what we learned from the Bogalusa Heart Study. Please sit down.
On a typical American diet, fatty deposits appear in the coronary arteries by age 3. By age 12, when most are entering junior high school, 70 percent have coronary fatty deposits. The deposits become much thicker and complex by the mid-teens, and virtually every adult has them by the age of 21. The Bogalusa Heart Study was largely ignored by the general public, although it was the subject of numerous conferences, two books, and over 400 scientific articles.
These fatty deposits represent the early stages of coronary artery disease, but what causes them? The answer is clearly high blood cholesterol levels, which in turn are caused by a diet too high in saturated fat and animal proteins. According to the American Heart Association, 40 million American children have abnormally high blood cholesterol levels. This is estimated by using the federal benchmark of 170 mg,/dl as the upper normal level. Most researchers now feel that this upper normal level should not exceed 150 mg/dl. In my own pediatric practice, I find that 1 out of 2 children tested have cholesterol levels exceeding 150 mg/dl.
Coronary artery disease is responsible for one-third of all adult deaths. It's really a childhood disease, which takes 30-40 years to reach its endpoint. Ideally, its prevention should start during the pre-kindergarten years, by changing children's eating habits. The answer is simple: A daily diet of vegetables, fruit, whole grains, and legumes. Meat, poultry, fish, and dairy products should be relegated to an occasional side dish, if at all. This is the way most of the world's population eats -- and they have no coronary disease.
The "moderate" American diet is really very radical. If some preventable industrial accident were killing this many people, something would be done. But for our greatest killer of all time, we simply consider it a natural part of growing old. The most vulnerable of all, now we know, are young, tender hearts.
Alas, regardless of their doom,
the little victims play!
No sense have they of ills to come,
Nor care beyond today.
Thomas Gray (1716-71)
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