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Risk Factors |
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A "risk factor" is a condition, behavior or anything about you that makes you more at risk for a disease than the general population. The following are risk factors for atherosclerosis in children:
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- High LDL (low-density lipoprotein) - This type of cholesterol is commonly known as "bad" cholesterol, because it builds up in the arteries and can be more harmful to your child. For information on how high LDL is diagnosed and treated, see Cholesterol and Triglycerides.
- Low HDL (high-density lipoprotein) - HDL is the "good" cholesterol that helps to remove LDL from the blood. HDL transports LDL to the liver, where it is metabolized into bile salts and eliminated from the body through the intestinal tract. High HDL therefore helps to counteract the effects of high LDL. For more information on how low HDL can be increased, see Cholesterol and Triglycerides.
- Elevated triglycerides - Triglycerides are a class of fat found in the bloodstream that makes up the bulk of total body fat. In adults, high levels of triglycerides are a major risk factor for heart disease. For more on triglycerides, see Cholesterol and Triglycerides.
- High blood pressure (hypertension) - Blood pressure is a measurement of the force of blood against the artery walls. Blood pressure that stays elevated over time is referred to as high blood pressure or hypertension, and can be dangerous because it makes the heart work hard to pump against extra pressure. High blood pressure is a leading risk factor for atherosclerosis, and medical research shows that without intervention, high blood pressure in children is likely to continue into adulthood. For more information, see High Blood Pressure.
- Pre-diabetes (insulin resistance) - As obesity rates in children climb, so does the incidence of "pre-diabetes," a condition that develops when the body needs to work extra hard to accommodate high levels of blood glucose. When the body is unable to compensate for these high glucose levels, this is called diabetes. Glucose is your body's main fuel, and insulin helps the body take up glucose from the blood into muscle, fat, the brain and other tissue. In diabetes, your body either can't make enough insulin or doesn't properly use insulin to take up glucose, resulting in a high level of glucose in your blood. Diabetes leaves your cells starved of energy, and the high blood sugar eventually can affect the function of arteries, kidneys and nerves. If blood work that measures glucose determines your child is pre-diabetic, there is a good chance your child will develop diabetes in adulthood or sooner.
- Metabolic syndrome - If your child has a cluster of three or more risk factors (high blood pressure, high triglycerides, low HDL, pre-diabetes, central obesity), your child has "metabolic syndrome," a condition that in adults has been tied to very high risk for heart disease, stroke and diabetes. No long-term studies have been done on children with metabolic syndrome, but it is believed that like adults, children who have it may be at a very high risk for heart problems in young adulthood. A Children's Hospital study on metabolic syndrome found that two-thirds of nearly 2,000 adolescents had at least one risk factor for heart disease, and almost 10 percent had metabolic syndrome. For more information on this study, see Research.
- Smoking - The risk of atherosclerosis is increased by both first and second hand smoke. Second hand smoke has been shown by Children's Hospital clinicians in a research study to reduce HDL, the good cholesterol, significantly. Any amount of smoke exposure has a negative effect on your health.
- Overweight - Excess weight is a risk factor for heart disease, independent of the adverse effects it has on your cholesterol and blood pressure. Being overweight is related to poor diet and not enough exercise.
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You probably wonder why your child developed one or more of the risk factors mentioned above. They usually occur for any of the following reasons, alone or often in combination:
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- Family history of any of these problems. These problems are often inherited. If one of a child's parents or siblings also has these problems, genetics may be to blame. If both parents have these risk factors, there is a very good chance their child will develop them.
- Being overweight. Weight problems typically result from a combination of factors including genetics, metabolism, environment and lifestyle. The latter two factors are primary influences behind an obesity epidemic in the United States. To determine whether your child is overweight, you can easily calculate your child's body mass index (BMI). BMI is a single number used to evaluate an individual's weight status in relation to height. For children, there are normal ranges for each age and gender. A BMI greater than the 85 percentile for age and gender indicates that your child is overweight. A BMI greater than the 95th percentile indicates obesity. The Centers for Disease Control and Prevention's BMI Calculator.
- Poor diet and lack of exercise. Sedentary pastimes like television, computers and video games have led to a general lack of fitness in today's youth. If your child is inactive and eats mostly processed foods, junk foods or fast foods, your child may have increased cholesterol levels or high blood pressure.
- Secondary causes. An underlying metabolic or endocrine disorder can influence cholesterol and blood pressure. These are "secondary" causes of cholesterol and blood pressure problems. The most common secondary cause of poor cholesterol in the first year of life is liver disease that obstructs the flow of bile, a liquid that helps digest fat. Later in childhood, endocrine disorders, especially hypothyroidism, diabetes and kidney diseases are leading secondary causes. In adolescence, medications are the most common secondary cause, and smoking, a well-known risk factor for heart disease in adults, begins to play a role among this age group.
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You may learn that your child has one or more of the risk factors above after a routine physical examination, which is one of the reasons why regular visits to your child's doctor are so important. Your child's blood pressure should be measured routinely, but cholesterol may not be. If your child is overweight, if you have a family history of high cholesterol or early heart disease, or you are concerned about your child's cholesterol and your doctor has not tested it, you may want to ask for a cholesterol test.
The National Cholesterol Education Program recommends cholesterol screening for children ages 2 and older with any of the following risk factors:
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- family history of heart disease under the age of 55, including parents and grandparents
- diabetes
- hypertension
- obesity
- sedentary lifestyle and poor diet
- history of Kawasaki disease
- history of kidney disease, metabolic disorders or obstructive liver disease
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