In 2010, the American Heart Association set the bold goal of improving the cardiovascular health of all Americans by 20 percent. In setting this goal, they created a paradigm shift from the treatment of cardiovascular disease to the promotion of cardiovascular health. Their recommendation was based on more than a decade of data showing adults who reach middle age without any major cardiovascular disease risk factors have a high chance of staying healthy well into old age. They don’t just have lower rates of heart disease and stroke; they also have lower rates of cancer, memory loss and kidney disease.
What is cardiovascular health? The American Heart Association defines cardiovascular health as having optimal blood pressure, blood cholesterol and blood glucose while also maintaining a normal weight, not smoking, being physically active and eating well.
Unfortunately, essentially zero Americans have all seven of these cardiovascular health factors — mostly due to the unhealthy American diet. Only 19 percent of teens and 8 percent of young adults have six of the seven.
As an adolescent medicine physician at Boston Children’s Hospital, my research focuses on how we can keep teens heart healthy as they transition to adulthood.
My patients and their parents often ask about cardiovascular health. Here’s how I answer some of the most common questions. …
Our pediatrician checked my teenager’s cholesterol and it came back high. What should we do?
In 2011, the American Academy of Pediatrics recommended routine cholesterol screening for all young people ages 9-11 and 17-21 years. Since then, we have seen many more young people screened for cholesterol problems, although overall screening rates remain low. Cholesterol is an important part of heart health, along with having a healthy diet, exercise, weight, blood pressure, blood sugar and avoiding all tobacco products. When doctors check cholesterol, it is important to think about all of these healthy heart factors.
The 2011 Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents recommend this overall heart healthy approach and give specific recommendations for high cholesterol.
Cholesterol serves an important function in our body, and not all high cholesterol is bad. In fact, we want the high-density lipoprotein (HDL) cholesterol, or “healthy” cholesterol, to be high (greater than 45 mg/dl is best). But the other cholesterol values—total cholesterol, low-density lipoprotein (LDL)-cholesterol and triglycerides—should be kept below certain thresholds if possible. (Total cholesterol less than 170 mg/dl, LDL cholesterol less than 110mg/dl, and triglycerides less than 90 mg/dl are best.)
Most young people with high LDL cholesterol and high triglycerides are best treated with diet and exercise changes. We recommend that these teens: …