Research shows that one in eight American children are at risk for heart disease and have at least three heart disease risk factors including high blood pressure, elevated triglycerides, low levels of HDL (good cholesterol), and high insulin levels.

Guidelines for fighting heart disease are now available for children. The guidelines, published in Circulation: Journal of the American Heart Association, include: participate in physical activity four to five times a week; have a “healthy plate” that includes half salad and vegetables, one-fourth starch and one-fourth protein; and reduce sedentary time.

Research has shown that arteriosclerosis (buildup of fat in artery walls) starts in childhood. Starting at age two, the National Cholesterol Education Panel (NCEP) recommends eating a diet with no more than 30 percent of calories from fat, fewer than 10 percent calories from saturated fatty acids, and fewer than 300 milligrams/day of cholesterol.

The National Cholesterol Education Program (NCEP) recently released their updated guidelines for controlling a major risk factor for coronary heart disease (CHD) - blood cholesterol levels. The guidelines reinforced the need for Americans to lower their levels of LDL (“bad”) cholesterol, as elevated levels of LDL cholesterol have shown to be a major cause of CHD. Under the new guidelines, 160 mg/dL of LDL is considered “high.” The guidelines advise that HDL (“good”) cholesterol not fall below 40 mg/dL. Total cholesterol greater than 240 mg/dL is considered “high.” Although the NCEP guidelines provide a variety of suggestions for dealing with CHD, the guidelines include strong recommendations for dietary and lifestyle changes. Key dietary guidelines include the consumption of no more than seven percent of calories from saturated fat and no more than 200 milligrams of dietary cholesterol per day. Up to 35 percent of total calories may come from total fat provided it is mainly in the form of monounsaturated and polyunsaturated fats. Weight reduction is advised if a person is overweight and physical activity (with a physician's approval) is also recommended. (Journal of the American Medical Association, May 16, 2001)

Sudden cardiac death has increased 10 percent for those aged 15 to 34, according to Centers for Disease Control and Prevention researchers at the American Heart Association's 41st Annual Conference on Cardiovascular Disease Epidemiology and Prevention. The increase (between 1989 and 1996) was even higher among young women - 30 percent. Although researchers can not fully explain the increase, they note that smoking, obesity and lack of physical activity are high in teens and may contribute to the problem. (Program and Abstracts of the 41st Annual Conference on Cardiovascular Disease Epidemiology and Prevention, March, 2001)

The theory that heart disease begins to develop at an early age has once again been confirmed. Scientists who examined autopsy reports of 856 people between the ages of 15 and 34 (all of whom died from accidents, homicides or suicides) found that those who smoked, were obese, had high blood pressure or high blood sugar levels showed early signs of heart disease in their arteries (e.g., fatty streaks and lesions). Henry C. McGill, Jr., M.D., senior scientist emeritus at the Southwest Foundation for Biomedical Research in San Antonio, Texas, said, “The study confirms the advice that has been given numerous times that children and young adults should adopt a healthy lifestyle and thereby try to control all of the risk factors, and not just focus on any one, like high cholesterol, smoking or obesity.” (Circulation, March 20, 2001)

In a 20 year long study, researchers involved with the Chicago Heart Association Detection Project have learned that risk factors for heart disease identified in young men (such as elevated cholesterol levels, elevated blood pressure, cigarette smoking) are strong predictors of the future risk of heart disease. Although studies have found that these risk factors may help predict the risk of death from heart disease in older people, few studies have examined the predictive capacity of risk factors in men under 40 years of age. The researchers concluded that the major risk factors (elevated cholesterol levels, elevated blood pressure and cigarette smoking - as well as age) were significantly associated with death from heart disease over the 20-year period. This information may help healthcare providers identify young men at risk of death from heart disease. (Annals of Internal Medicine, March, 2001)

Family history of heart disease may be as strong a risk factor as more traditional risk factors, according to new research from the University of Texas Medical School at Houston. “It appears that family history alone can carry the same weight as the standard risk factors through mechanisms we do not understand. What's important is that we find early disease in these family members long before it causes symptoms and we can offer intense preventative and reversal treatment,” said K. Lance Gould, M.D., professor of medicine at the University. Dr. Gould and his colleagues examined 18 people with coronary heart disease and 32 of their immediate family members (such as parents or siblings) who did not have symptoms of heart disease. The researchers also used two control groups: one group with heart disease risk factors but no family history of heart disease and another group with no risk factors and no close family members with heart disease. Participants underwent positron emission tomography (PET) imaging - which is used to find early signs of heart and blood vessel disease, before clinical signs (such as heart attack, stoke or chest pain) occur. The PET imaging revealed that half of the participants with a history of family heart disease but no known clinical symptoms had abnormal blood flow - which can signal early atherosclerosis. (Circulation, January 29, 2001)

Margarine can be included as part of a healthy diet, finds new research from the University of Texas Southwestern Medical Center in Dallas. This was the first time that biological families were enlisted in a study to directly compare the effects of an unsaturated fat diet (margarine) versus a saturated fat diet (butter) on cholesterol levels in both adults and children. Among the 46 families who participated in the study, there were 92 parents and 134 children in all - some as young as six years old. The families followed a margarine-based diet for five weeks. They then switched to a butter-based diet for a period of five weeks. The researchers found that compared to butter, the margarine diet lowered LDL cholesterol, in adults by an average of about 11 percent without affecting levels of HDL, or “good” cholesterol. Children also benefited from eating the margarine instead of butter, with a similar reduction in LDL cholesterol of about 9 percent. Because the study involved families, the researchers also looked at why some individuals respond more positively to a cholesterol-lowering diet. They found that shared genes and environment play a role. “Although differences in response to diet were observed, 80 percent of participants lowered their LDL cholesterol level on the margarine-based diet compared to the butter diet,” said Margo Denke, M.D., associate professor of internal medicine and senior author of the study. (Journal of the American Medical Association, December 6, 2000)

This study revealed that most adolescents (over 80 percent) between the ages of 13 and 18 exceeded dietary recommendations for total fat and saturated fat intake. Forty-nine percent exceeded the recommended cholesterol intake. More than one-third (37 percent) had elevated total cholesterol levels and 29 percent had elevated LDL cholesterol levels. A major finding was that those with high cholesterol intake were more likely to show early signs of atherosclerosis in their arteries. The authors concluded, “These data support the assumption that diet is important in the etiology of atherosclerosis in its beginning stages in teenagers, as it is with atherosclerosis in the adult.” (Journal of the American College of Cardiology, February, 2000.)

The American Heart Association’s (AHA) 2000 Heart and Stroke Statistical Update reports that if all major forms of heart and blood vessel disease were eliminated, U.S. life expectancy would rise by approximately seven years. It would also save the nation more than $300 billion dollars. Although the AHA notes that there has been remarkable progress in the battle against heart disease, it remains the number one cause of death for both men and women. The report also points to several disturbing trends in relation to many preventable and/or treatable risk factors such as smoking, physical inactivity, obesity and high blood pressure. Although the number of people who smoke has dropped, the number has leveled off. Smoking is on the rise among U.S. teenagers and is expected to increase throughout the world in the next century. The report also finds that only 22 percent of adults are physically activity for 30 minutes a day at least five times a week. The number of obese and overweight Americans has grown to over 110 million, including children as young as six. Fifty million Americans are affected by high blood pressure and of those who are affected, only 27 percent have sought medical treatment to control this risk factor. (American Heart Association Report, December 30, 1999)

A study presented at the American Heart Association Scientific Sessions finds that heart disease begins in childhood, despite the fact that symptoms may not appear until a person is middle-aged or older. Researchers used ultrasound to examine the arteries of 181 heart transplant recipients two to six weeks after the transplantation. The hearts were donated from people who were known to be free of heart disease. However, the researchers found that atherosclerosis was present in the arteries of all of the donors, including teenagers. After an analysis of other risk factors, the researchers found that age was independently associated with the degree of atherosclerosis. Dr. E. Murat Tuzcu, director of the Intravascular Ultrasound Laboratory at the Cleveland Clinic Foundation, Cleveland, Ohio, and senior author of the study, said, "This study of individuals with no known heart disease demonstrates that heart disease begins at a very young age and well-developed plaque deposits are present in one in six teenagers." (Research presented at the American Heart Association Scientific Sessions, November 9, 1999)

Researchers have found that walking is beneficial even for elderly men. A study consisting of 2,678 men between the ages of 71 and 93 revealed that men who walked about two miles a day cut their risk of heart attack in half when compared with those who walked a quarter of a mile. The research also showed that for every additional half mile walked the risk for a first-time heart attack dropped by 15 percent. For men who walked less than a quarter mile a day, the risk of heart disease was 5 percent compared to a 2.5 percent risk in those who walked more than 1.5 miles per day. The participants were part of the Honolulu Heart Program (HHP) in Oahu, Honolulu. Researchers noted that the study’s findings may be extended to not only younger men, but women as well, as other studies such as the Nurses’ Health Study and the Harvard Alumni Study have found similar results. One of the study’s authors and professor of biostatistics at the University School of Medicine, Dr. Robert D. Abbott, said, "Encouraging the elderly to become active could have important health benefits. This is especially important because walking can be easily incorporated into a person’s lifestyle and daily routine." (Circulation, July 5, 1999)

The Bogalusa heart study reinforces the importance of a healthy weight in relation to heart disease risk. The results indicated that children aged 5 to 17 who were overweight were 2.4 times more likely to have elevated cholesterol levels. Of those children who were overweight (a total of 813), more than half (58 percent) had at least one risk factor for heart disease. According to government statistics, approximately 25 percent of children between the ages of 6 and 19 are overweight, which may place an alarming number of children and adolescents at an increased risk for heart disease. (Pediatrics, June 6, 1999)

The American Heart Association (AHA) has added obesity to its list of major risk factors that people can control to prevent death and disability from coronary heart disease, the cause of heart attacks. These major risk factors include high blood cholesterol, high blood pressure, sedentary lifestyle, smoking and now obesity. Heredity, increasing age and being male are also regarded as risk factors by AHA, but they cannot be changed. AHA just upgraded the status of obesity from a contributing risk factor to a major risk factor for heart attack due to strong scientific evidence of obesity’s impact on heart disease risk and due to the increased prevalence of the condition in the population. Research has shown that modest weight reduction 5 to 10 percent of body weight can reduce high blood pressure and total blood cholesterol. Modest achievable weight loss can also help control diabetes in some people. One reason cited for the epidemic is that although Americans are eating a lower percentage of total calories from fat, they are eating more calories overall. More details about this new major risk factor can be found in an article titled "American Heart Association Call to Action: Obesity as a Major Risk Factor of Coronary Heart Disease." (Circulation, June 2, 1998)

A second major study from a group of researchers in Finland confirms that switching to soft margarine from butter, and from whole milk to reduced-fat milk, can have a dramatic effect on heart disease risk. The study attributes the decreased intake of saturated fat and the subsequent reduction in heart disease to the introduction of low-fat and soft margarines as well as low-fat and fat-free milk in the last 20 years. This same research group published similar findings in the November 1996 Annals of Internal Medicine. In both of these research papers, the researchers note that there were four dietary changes that occurred during the past two decades in Finland that can explain their observations of reduced heart disease rates. According to the researchers, these changes include: 1) introduction and promotion of oil-based soft margarine in the 1970s; 2) introduction and promotion of low-fat oil-based and water-based margarine in the 1980s; 3) introduction and promotion of low-fat milk; and 4) introduction of fat-free (skim) milk in the early 1980s. (Circulation, March 27, 1998)

Moderate restriction of total fat (to 26-30 percent of total calories) is an effective way to reduce risk of heart disease, according to new research. By comparison, more aggressive lowering of dietary fat intake was found to offer no further benefit to research subjects with elevated blood cholesterol levels. While diet is the first step in management of hypercholesterolemia, this research found that cutting fat intake too low (below 22 percent) could even cause some adverse effects. According to the researchers, the findings of this study validate the National Cholesterol Education Program’s dietary guidelines. (Journal of the American Medical Association, November 12, 1997)

Older people should not let low blood cholesterol levels fool them into thinking they may not be at risk for heart disease. A new study finds that a person’s cholesterol levels during middle age are better predictors of heart disease risk than their cholesterol levels during older age. Because cholesterol levels may spontaneously decline with age, researchers now believe that a person should reduce his/her cholesterol levels much earlier in life and keep them down. Even though an older person’s cholesterol levels might appear normal, his/her past history of elevated blood cholesterol levels should make them pay greater attention to preventive measures like nutrition and physical exercise. (Research presented at the American Heart Association Scientific Sessions, November 11, 1997)

Even a minimal increase in obesity has the potential to increase the risk of heart disease, even if other risk factors (e.g., diabetes, high blood pressure) are not present. "Overweight" in this study is defined as having a body mass index (BMI) greater than 25. For instance, a 5’5" 135 pound woman has a BMI of 22, while a 5’10" 180 pound man has a BMI of 26. By undertaking a reduced calorie diet and exercising, most overweight individuals with BMI’s between 25 and 30 can improve their overall health. Those with higher BMIs may need additional medical intervention to reduce their weight. (Circulation, November 4, 1997)

Americans are only getting half as much fiber as they need, says the American Heart Association (AHA). Because eating enough fiber-rich foods should be part of a diet to lower blood cholesterol and risk of heart disease, consumers are urged to increase their intake to 25- 30 grams of fiber per day. Eating a variety of whole grains, legumes, vegetables and fruits can add valuable fiber to the diet in addition to important vitamins and minerals. However, AHA notes that high-fiber foods should complement (and not be a substitute for) a low- saturated fat, low-cholesterol diet. (Circulation, June 17, 1997)

In a review of 20 previous studies that examined the potential health effects of margarine vs. butter, researchers conclude that replacing about two tablespoons a day of butter with soft, tub margarine would theoretically predict a reduction in coronary heart disease risk of 10 percent. This analysis of studies that were published between 1957 and 1995 found that risk factors such as blood cholesterol levels were favorably affected by soft margarines, primarily due to their reduced level of saturated fat and trans fat. (Atherosclerosis, May, 1997)

90 percent of women with diagnosed heart disease and "bad" cholesterol levels (LDL or low-density lipoprotein cholesterol) are not being treated rigorously enough with drug and diet therapy, according to a nationwide study. Some experts believe that part of this problem may be the belief that women are less threatened by heart disease than men. (Journal of the American Medical Association, April 22, 1997)

To avoid having low levels of "good" cholesterol (HDL or high-density lipoprotein cholesterol), some postmenopausal women may want to consider consuming low-carbohydrate diets that contain moderate amounts of protein and unsaturated fats. New research finds that a diet containing 40-45 percent of its calories from unsaturated fat may be helpful for some individuals to reduce the levels of LDL cholesterol while maintaining a high level of HDL cholesterol. However, saturated fat intake must still be limited to 10 percent or less of calories. (American Journal of Clinical Nutrition, April 17, 1997)

The "Dietary Approaches to Stop Hypertension" (DASH) research project (which was funded by the National Heart, Lung and Blood Institute) concludes that a diet low in total fat, saturated fat and cholesterol, and high in fruits, vegetables and low-fat dairy products, may help lower blood pressure. Investigators believe that the DASH diet has the potential to reduce the U.S. incidence of coronary heart disease by 15 percent and strokes by 27 percent. (New England Journal of Medicine, April 17, 1997)

Lifestyle changes such as losing weight, exercising, and reducing intake of fat and cholesterol can slow or even slightly reverse the process of clogging arteries. Using ultrasound to measure arterial clogging in the carotid artery of the neck, researchers determined that these are three of the easiest lifestyle changes one can make to reduce risk of arteriosclerosis. (American Journal of Clinical Nutrition, April 1997)

A meta-analysis of nearly 400 studies concludes that increasing polyunsaturated fat intake can decrease total and LDL cholesterol as well as increase HDL cholesterol. The researchers conclude that replacement of 60 percent of dietary saturated fat with unsaturated fat, and avoidance of 60 percent of dietary cholesterol, can reduce total blood cholesterol levels by 10-15 percent. (British Medical Journal, January 11, 1997)

Teenagers who eat fatty foods may increase their risk of heart disease in later life, according to new research that analyzed fatty deposits in the arteries of teenagers who had died of other causes. The research correlated arterial deposits and associated damage to the blood vessels with high levels of blood cholesterol. No differences were found between genders. (Arteriosclerosis, Thrombosis and Vascular Biology, January 1997)

Researchers exploring the role of vitamin E in the prevention of coronary heart disease found that there was a significantly decreased incidence of coronary death among more than 34,000 postmenopausal women who ate diets comprised of foods rich in vitamin E (e.g., margarine, mayonnaise, salad dressings, nuts). (The New England Journal of Medicine, May 2, 1996)