Heart Disease Starts in Childhood

Image Credit: James MacDonald / Flickr. This image has been modified.

Stopping Heart Disease in Childhood

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 soldiers’ hearts had gross evidence—meaning visible-to-the-eye evidence—of 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 of 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 ten. What’s accounting for this buildup of plaque even in childhood? In the ‘80s 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 years old, 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 our score, the higher the likelihood we have these lesions growing in the arteries that pump blood and oxygen to our heart. So if we’re young and we smoke, our risk goes up by one point. If we have high blood pressure at such a young age, that’s four points. If we’re an obese male, that’s six points, but high cholesterol was the worst of all. If our non-HDL cholesterol (meaning the total cholesterol minus the good cholesterol) is above 220 or so, our risk increased eight times more than if we 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, it’s closer to a one in five (20%) chance you have some serious heart disease, and if you have really high cholesterol it could be closer to one in three (33%).

In the video, Heart Disease Starts in Childhood, you can see what happens to our risk if we bring our cholesterol down to even just that of a lacto-ovo vegetarian, or if we exercise to boost our HDL, etc. It shows 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.” And by early in life they meant infancy.

Atherosclerosis, hardening of the arteries, begins in childhood. By age ten 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.

For those of us older than ten years of age, the choice likely isn’t whether or not to eat healthy to prevent heart disease, it’s whether or not we want to reverse the heart disease we likely already have.

Drs. Dean Ornish and Caldwell Esselstyn Jr. 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 start unclogging 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:

Heart disease is a choice.

-Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my videos for free by clicking here and watch my full 2012 – 2015 presentations Uprooting the Leading Causes of Death, More than an Apple a Day, From Table to Able, and Food as Medicine.


Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.

13 responses to “Stopping Heart Disease in Childhood

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  1. Sounds like the saturated fats are the biggest problem here, and so many parents feed their kids cookies and cakes and sweets dense in vegan saturated fats. Please do more (you do a lot already, thanks you!) to highlight to your viewers, most of whom are vegan, it seems, the harm being done (it seems) by the fat-laden vegan junk food, as well as dairy-fat junk food.

    I look at the Japanese eating their fish, and they don’t seem to have the heart disease issues we have, but I don’t think the culture over in Japan ingests large amounts of dairy fat cookies, cakes, etc. and vegetable-fat-laden cakes and cookies…potato chips, fried corn chips, and other high-vegetable-fat packaged (and baked) goods. USA seems to live on bags of chips and cookies as snack for kids, and many parents think “oh, it’s vegan, it’s OK.” I think getting this vegan message across to your viewers, and future viewers, is where you might provide the most benefit.

  2. If family doctors gave this information to new parents taking babies in for the first year of check-ups, think what a difference it might make. Parents might start feeding their babies and toddlers boiled potatoes and steamed broccoli instead of hot dogs and French fries.

    1. Thanks BB. I repeatedly clicked the up arrow but it only lets me vote once. Otherwise you’d be up to 100+ “likes”

  3. What do you think of the research-based differentiation that many nutrition doctors make about the two kinds of LDL? One particle is large and fluffy and passes through the arteries, and one is small and dense and gets stuck in there, forming plaque. This was on Sanjay Gupta and several other health shows. Also the recent large study that showed that saturated fat intake had no effect on health? It’s hard for me to decide what to do when highly respected doctors disagree among themselves. I don’t have the advanced medical training.
    John S
    PDX OR

    1. John S: You are not the first person to ask these questions.B oth Toxins and MacSmiley gave such great answers to the first question that I saved their answers. I copied those answers below for you.

      Your second question about saturated fats has also been well answered by other people. If you still have that question after reading through the information and links below, let me know, and I will try to find those answers.
      Re Large and fluffy LDL being benign or even beneficial: ALL ApoB-containing particles (found in LDL of all sizes) are atherogenic.
      Large, small LDL diameters increased CV mortality risk
      Grammer TB. Eur Heart J. 2014;doi:10.1093/eurheartj/ehu055.

      Letter from Columbia University doctors refuting the large LDL fallacy promulgated by Dr. Oz:

      A nice wrap up of the issue at Plant Positive:
      25 Cholesterol Confusion 8 A Large and Fluffy Distraction


      From the editor in chief of the American Journal of Cardiology.

      “As shown in Figure 1, most of the risk factors do not in themselves cause atherosclerosis [heart disease]…The atherosclerotic risk factors showing that the only factor required to cause atherosclerosis is cholesterol.”

      Particle type is irrelevant when one gets low enough, this is evident here and has been identified several decades ago, that those who have total cholesterol 150 or below essentially do not develop heart disease.

      “If everyone smoked 20 cigarettes a day, then clinical, case-control and cohort studies alike would lead us to conclude that lung cancer was a genetic disease; and in one sense that would be true, since if everyone is exposed to the necessary agent, then the distribution of cases is wholly determined by individual susceptibility…In the case of cigarettes and lung cancer it so happened that the study populations contained about equal numbers of smokers and non-smokers, and in such a situation case/control and cohort studies were able to identify what was also the main determinant of population differences and time trends.”

      The same can be applied to heart disease, the cholesterol levels of those who get heart disease and those who do not is basically the same for most of the population. “The painful truth is that for such an individual in a Western population the commonest cause of death—by far—is coronary heart disease! Everyone, in fact, is a high-risk individual for this uniquely mass disease.”

      Again I would encourage you to view the first link I shared in my first post to you.

  4. I’ve been reading reviews of “The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet” by Nina Teicholz, which seems to refute much of the information found on nutritionfacts.org.

    Perhaps the book was sponsored in some way by the meat and dairy industries, but maybe not. I’d like to hear Dr. Greger’s and others response to the book.

  5. The problem is multifactorial: too many carbs and sugars; too many vegetable fats and too high a ratio of omega-6 to omega-3 essential fatty acids; very poor quality meat having, again, too high a ratio of omega-6 to omega-3 essential fatty acids; no where nea enough exercise or overall body movement/activities…

    Unfortunately, trials and studies done on foods are inherently very unreliable. Studying one ingredient is useless because ingredients almost never have health impacts (positive or negative) in isolation to other ingredients. Studies on a particular food are also unreliable as there are too many variables involved (both in the food, as well as in the lives of the people taking part in the study).

    The more we increase our knowledge about isolated nutrients, the less we seem to know and understand about a particular food(s) as a whole and its impact on our health.

    1. Hi lason,

      Glad to see some additional sanity on this blog! Those stuck in vegan or pale or other isolated this-food-is-bad ideas just cannot see the big picture. Including Dr. Gregor and total paleo promoting physicians as well.

      Bad foods are processed foods and junk and isolated sugar etc. etc. etc. Real food is good food. Whether it contains cholesterol or saturated fat or not.

      But yes, modern raised poor quality meat has problems with skewing the essential fat ratios, antibiotics and more. Plus putting children on low fat, low cholesterol vegan diets is dangerous indeed.

      White bread, not enough veggies, processed foods, chemical contamination in foods and so much more is involved.

      These blogs, while sometimes providing useful information, just don’t cut the mustard in trying to put together the bigger picture of foods relationship to disease and health.

      Thanks again for your post!

  6. This is a well written summary of what the pizza, ice cream, and hot dog diet continues to do to our children. One of mine just had a 10th birthday and annual physical which, of revealed nothing about the state of her arteries.

    Is any effort underway to have cholesterol checks performed as part of a child’s annual physical ? At least we’d have some idea of the damage that has potentially already been done.

    I assume the pediatricians will do it ?

  7. Something even scarier is some kids as young as three have been found to have fatty streaks. It’s pretty horrifying considering not even of school age yet.

  8. I am looking for answers as I am having a discussion about essential or primary hypertension and whether it truly is “idiopathic in 95% of cases” with my brother in law who is a doctor. I may be tarnished in my thinking as a cardiac ICU nurse and Cath lab nurse, but my feelings after seeing all the bypasses and stent placements and hearing about fatty streaks developing in childhood and even being found in autopsied fetuses makes me wonder if essential hypertension may actually be due, not only to the salt content of processed foods and animal products, but also from the long life of cholesterol build up. The internet is full of “answers” that say it is 95% idiopathic. Is that really the case?

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