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Heart Healthy Habits for Your Children&their Future

Online Health Chat with Dr. Peter Aziz

May 2, 2012

Introduction

Cleveland_Clinic_Host: Did you know that some of the most important risk factors that contribute to the development of coronary artery disease and stroke in adults have their origin in childhood? These factors include hypertension, obesity, cholesterol, and unhealthy lifestyles. The best medicine is prevention, and as a parent it’s your job to instill heart healthy habits in your child.

Get started with these tips and guidelines from the American Heart Association:

  1. Be a good role model: If your kids see you trying to eat right and getting physically active, they’ll take notice.
  2. Get the whole family moving: Plan times for everyone to be active together. Take walks, ride bikes or go swimming. Just get active!
  3. Make dinner time a family time: Everyone develops good eating habits together!
  4. Stay involved: Be an advocate for your kids. Make sure your children’s pediatrician is monitoring cardiovascular indicators like BMI, blood pressure, and cholesterol.

Cleveland Clinic Children's Hospital Department of Cardiology and CT Surgery has an outstanding reputation for successfully handling the most complex cases of heart disease in children. Our cardiologists, pediatric heart surgeons, and anesthesiologists are among the most highly trained and experienced in the world, and the team is the largest and most experienced in Northern Ohio. In addition to our clinical specialists, we rely on the entire pediatric team to ensure the very best results for our child and adolescent heart patients, including the referring physician, the patient's family, specially-trained cardiac nurses, allied health professionals, social workers, and child life specialists.

Our Pediatric Preventive Cardiology and Metabolic Clinic is a multidisciplinary team of physicians, nurse practitioners, dietitians, exercise physiologists, and other healthcare professionals who take a comprehensive approach to preventing the onset or progression of cardiovascular and metabolic conditions in high-risk patients. Our team works with families to create individualized programs to meet the specific needs of each patient.

Dr. Aziz completed his pediatric cardiology fellowship at the Children's Hospital of Philadelphia in 2010 and continued his training there in pediatric electrophysiology. During his fellowship, Dr. Aziz was awarded a training grant under the National Institute of Health (NIH) to investigate genotype and phenotype correlations in pediatric patients with long QT syndrome. Dr. Aziz also acquired skills in catheter ablation of pediatric arrhythmias and device (pacemaker and ICD) implantation. Following his fellowship, Dr. Aziz joined the Cleveland Clinic as a pediatric electrophysiologist. He is active in the training and teaching of medical students, residents, and fellows, an activity that continuously inspires him. Dr. Aziz is also quite active in research and was the recent recipient of the SADS 2011 Young Investigator Award for his work on long QT syndrome.

Cleveland_Clinic_Host: To make an appointment with Dr. Aziz or any of the pediatricians or pediatric specialists at Cleveland Clinic Children's Hospital, please call 216.444.KIDS (5437) or call toll-free 800.223.2273, ext. 5437. For more information on Pediatric Cardiology and Cleveland Clinic Children’s Hospital, visit us online.

Cleveland_Clinic_Host: Welcome to our Online Health Chat with Cleveland Clinic specialist Dr. Peter Aziz. We are thrilled to have him here today for this chat. Let’s begin with some of your questions.


RISK FACTORS

boom_boom: What are the risk factors for children developing heart disease? Should kids have their cholesterol checked?

Dr__Aziz: Great question, though complicated. In young healthy children, routine screening is not advised. The single biggest risk factor is having a family member with early cardiovascular disease (heart attacks) as rarely, inherited/genetic factors can play a role. As a pediatrician, we recommend limiting television/video games and encouraging aerobic activities.

kittykat: What role does genetics play for a child developing heart disease later in life? Is it really genetics or is it life habits and environmental risk factors?

Dr__Aziz: Excellent question, mainly because we don't know the answer to that quite yet. Though several genetic conditions contribute to cardiac risk, many of these genetic markers have not been clearly defined. Moreover, we know for certain that life-style changes (increase diet and exercise) can greatly reduce the risk of developing heart disease later in life. Ultimately, there is a combination of risk factors that contribute to heart disease. As physicians, we recommend altering what the patient has control over. Since we can't change our parents, we can only choose to make healthy choices.

call_me: How much do sleep and exercise weigh in on heart healthy habits?

Dr__Aziz: Sleep and exercise are extremely important. The lack of adequate sleep has consequences as far-reaching as school performance and even relative happiness. Exercise provides an increase in metabolism and, when performed safely, can provide weight loss, an improved sense of well-being, and a decrease in blood pressure. Unfortunately, many children spend the majority of their free time watching television and playing video games. We are starting to see the negative consequences of these choices as practicing pediatricians.

brandon: Diabetes can lead to heart disease and more children are becoming diabetic, especially because of obesity. My question is, “should kids have their blood sugar checked?”

Dr__Aziz: Though diabetes is more prevalent, particularly in the United States, no routine screening is advised. The obesity epidemic in children has several consequences, one of which is type II diabetes. As clinicians, we perform screening tests on pediatric patients when indicated by symptoms. For an obese patient, blood sugar levels are a reasonable screening tool.

go_on: I have two boys, 14 and 16, and they eat a lot. Now, they are skinnier and active, but is it still OK for them to eat so much? I mean, they eat a lot...all the time!

Dr__Aziz: What goes in must come out. So, if your boys are exercising continuously, they will also need to eat continuously. More important than how much they are eating is what they are eating. Regardless of the quantity, my general rule of thumb is "eat real food." In other words, if the food requires processing and additives, I would avoid it.

go2: My daughter had her cholesterol tested by our primary care physician as part of her physical before going to college, and we learned that she has both high LDL and HDL levels. The doctor explained that at this point there is no need to worry because her “good” cholesterol level was much higher than her “bad” cholesterol. Is that true that there’s no need to worry? Should we be concerned because both of her cholesterol levels are high? What can we do to bring them down? We are really concerned about the long-term effects of having high cholesterol.

Dr__Aziz: Not to evade the question, but it depends on several factors. A high LDL (depending on the value, of course) may not be of clinical significance in an otherwise healthy young adult. In children and young adults, the single biggest risk factor for developing heart disease is having a strong family history for early heart disease (heart attacks in family members < 50 years old). In obese patients, an elevated LDL is something very different than in a healthy, active teen, for instance.

HDL, or "good cholesterol," is considered protective for cardiovascular disease. Patients with low HDL are sometimes treated, but patients with higher HDL are considered to be "lucky," for lack of a better term.


TREATMENTS, INCLUDING MEDICATION

EW: 1) My 23-year-old son has poor heart history on one side of family, high cholesterol and elevated lipoprotein(a) (LPA) and is now on 20 mg of rosuvastatin (Crestor®), which has really helped the cholesterol numbers. But LPA remains high. I know about niacin, but it is tough to tolerate. What else can he consider to reverse his LPA given that it is considered a risk factor, or would you not focus on it at this age? 2) As it relates to healthy habits, he exercises and limits intake of red meat. Unfortunately, he is allergic to many fresh fruits and vegetables that would be helpful to him--they cause his throat to tighten. Given the importance of eating plant-based diets, I'm at a loss given the allergies and would so appreciate any other ideas! Thanks for doing these online chats.

Dr__Aziz: Unfortunately, not many interventions effectively change LPA levels. Specifically, diet and exercise are not known to decrease LPA levels and most statins are ineffective as well. A study this year suggests that atorvastatin may reduce LPA levels, but I think more research needs to be done prior to starting this particular statin. I agree with you that although niacin may be effective, side effects do limit its utility. If that's the case, aspirin has also been shown to be effective and has a relatively safe risk profile. I would recommend discussing these options with your son's prescribing physician.

lundenm: What is considered high cholesterol for kids, and do they start on cholesterol medication?

Dr__Aziz: Total cholesterol levels should be less than 170 mg/dL. Their LDL cholesterol should be less than 110 mg/dL, HDL levels should be 35 mg/dL or greater, but preferably over 60, and triglycerides should be 150 mg/dL or less.

Treatment is typically dictated by cause. If a child is inactive and obese, we usually start with life-style changes (diet and exercise) prior to initiating medical therapy.

pretty_girl: What about blood pressure? At what age should blood pressure start to be part of a routine check? What is considered high and are medications ever necessary for kids with high blood pressure?

Dr__Aziz: Blood pressure should be checked at every routine examination performed by a pediatrician. Normal values depend on age, gender, and height. If the blood pressure is elevated, your doctor has to determine the cause, which often dictates treatment. For instance, diet and exercise can reduce blood pressure in children that are inactive and obese. In other cases, kidney and heart problems can cause high blood pressure, and the treatment can vary.

This is a website that states percentiles for normal blood pressure depending on age, gender, and height. www.nhlbi.nih.gov/guidelines/hypertension/child_tbl.pdf

mandyx: My child was recently diagnosed with supraventricular tachycardia (SVT), and his doctor said that he may need to go on prescription medication for an extended period of time. Is that normal? I’m concerned that medication could have a long-term negative effect on his health, is that possible? Are there other treatment options available?

Dr__Aziz: As a pediatric electrophysiologist, SVT is a problem that I see on a daily basis. Depending on the age of your child, there are several options for treatment including, but not limited to, medication. Typically we prescribe beta-blockers as first-line therapy for most types of SVT. Though side effects exist with beta-blockers, children tend to tolerate the medication well when it is introduced gradually. Alternatives exist, and in some patients that request to not take medication, a procedure can be performed to eliminate the SVT. The decision to perform the ablation is complicated and should be discussed with an experienced electrophysiologist.

lisamchil: My 13-year-old has type 1 diabetes and high cholesterol. His LDL has come down from 150 to 129 over the last 5 years; his HDL is in the 50s. His weight is good, he likes fruits and certain veggies, but he dislikes sports, and some exercise. It's early for medication, so I'd like any ideas on diet you can offer other than the high fiber stuff I read everywhere. Thank you!

Dr__Aziz: Tough question. Optimizing dietary habits in a young teenager can be very difficult, particularly in those patients with type I diabetes. From a cardiovascular perspective, we commonly request the assistance of dieticians/nutritionists to aid us in making these recommendations. As far as exercise, sports participation is not absolutely necessary. Many children are just as active as their "athletic" peers engaging in various outdoor activities. I would encourage you to cultivate his activity interests, whatever they may be.


SPORTS-RELATED HEART HEALTH

we_are_strong: My son’s training and conditioning coach told him that aerobic exercise AND weight lifting will help his heart health. Is that true? I’m concerned that premature weight lifting could be too much stress on his heart and could cause damage.

Dr__Aziz: Premature weight lifting, particularly of heavy weights, can stunt growth in a child that has not reached full growth capacity. Weight lifting must also be supervised to ensure safety and to ensure that the motions are performed correctly. Injuries are not uncommon in patients that lift weights, particularly those with poor form.

Cardiovascular activity is generally safe as long as one adheres to good dietary habits. Certainly, any participant must "know his or her limit," and partnered participation is always encouraged.

pst98: My son plays football for his high school and I am concerned that something could happen to him on the field, in particular during the summer training months. Other than the mandatory sports physical, do you recommend any further testing to ensure that his heart is healthy?

Dr__Aziz: As with any sports participation, a thorough history and physical examination are mandatory components to pre-screening. Rarely, certain heart conditions can place a patient at risk for sudden cardiovascular events during exercise, but certain clues typically exist during the screening process to identify at-risk patients. At this point, no other recommendations for pre-participation screening have been made by the American Academy of Pediatrics.

leads: My son plays sports, and I noticed that all of his teammates drink high energy drinks prior to playing - sometimes more than one. I have told my son not to drink them because I would think it would not be safe prior to playing a game. I don't think he does - but do you have any knowledge about those drinks and what they do? Wouldn't your heart rate speed up? Will consuming high energy drinks over an extended period of time have an effect on the heart? I’m concerned for his teammates.

Dr__Aziz: Excellent question. We are beginning to learn more about "energy drinks," and as a physician, I routinely advise against them. In an otherwise healthy patient, the risk associated with consuming energy drinks is extremely low. In rare cases, a child may be predisposed to a heart condition wherein consuming large quantities of "energy drinks" can be unsafe and detrimental. Unfortunately, many of these patients are not identified until they consume energy drinks and have an issue. Therefore, avoidance is prudent in all cases.


MISCELLANEOUS

butifull: How often are children’s blood pressures checked? I don't remember mine ever having been done. Should I request that their doctor do it?

Dr__Aziz: A blood pressure should be checked at every routine doctor's visit. Perhaps it was checked and never communicated to you. I would encourage you to ask your physician if they have a recent value.

mine_and_yours: What would be the warning signs that a doctor would pick up on to check for heart problems in a child?

Dr__Aziz: This is a broad question to tackle. "Heart problems" in a child are very rare. Typically, young children with heart problems are born with some type of defect (hole in the heart, valve problem) which typically manifest as poor growth and exercise intolerance. There are a variety of other heart problems that exist that have a very different subset of presentation. For example, some children have arrhythmias which manifest as palpitations or even passing out. I would advise you to discuss any concerning signs or symptoms with your physician. Hope this helps!

nys: My child has long QT syndrome and this is the first year I am sending him to overnight camp - in another state! What should I share with the health staff at the camp, especially if they are not familiar with this syndrome?

Dr__Aziz: The single most important preventative measure I would recommend is ensuring that the camp is equipped with an automated external defibrillator (AED) and that someone at the camp is trained in how to use the AED.

jrst9: My daughter she says she feels a skip in her chest every so often. Is that normal for a child? At what point should I be concerned and take her to the doctor? What are the typical tests done to check the problem?

Dr__Aziz: As a pediatric electrophysiologist, I see many patients with this very complaint. Isolated skipped or extra beats are very common and benign. Rarely, these extra beats are a sign of an underlying cardiovascular problem. We recommend evaluation by a physician to ensure that there are no signs of cardiovascular disease. Again, this is not typically the case, as this is a common complaint in otherwise healthy children.


Closing

Cleveland_Clinic_Host: I'm sorry to say that our time with Cleveland Clinic specialist Dr. Peter Aziz is now over. Thank you for taking the time to answer our questions today about Heart Healthy Habits for Your Children and their Future.

Dr__Aziz: Excellent questions. Thank you for joining the chat today.


More Information

Cleveland_Clinic_Host: To make an appointment with Dr. Aziz or any of the pediatricians or pediatric specialists at Cleveland Clinic Children's Hospital, please call 216.444.KIDS (5437) or call toll-free 800.223.2273, ext. 5437. For more information on Pediatric Cardiology and Cleveland Clinic Children’s Hospital, visit us online.

A remote second opinion may also be requested from Cleveland Clinic through the secure eCleveland Clinic MyConsult Web site. To request a remote second opinion, visit eclevelandclinic.org/myConsult

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