Observations from pediatric epidemiology studies over the past 20 years document that
atherosclerosis and essential hypertension begin in childhood. Evidence of coronary
artery disease and hypertensive cardiovascular renal disease is found and relates
strongly to clinical cardiovascular risk factors. Obesity, especially central obesity,
and hyperinsulinemia are commonly found, and these cluster with other risk factors.
Lifestyles, such as poor eating behavior and tobacco usage, also begin early and influence
cardiovascular risk. The implication from these pediatric observations is that intervention
should begin early to prevent unhealthy lifestyles and encourage adoption of healthy
behaviors. Where adult heart diseases pervade the major part of the United States
population and other industrialized cultures, various epidemiologic strategies of
prevention are needed. A high-risk, clinical approach can be applied to individuals
with heart disease or to individuals with underlying risk factors and their families.
Primary and secondary prevention are both important and should be implemented by primary
care physicians. A population approach is also needed because of the widespread occurrence
of heart disease. A public health approach to prevention can occur through health
education and health promotion programs. Physicians should play a role in encouraging
prevention for the general population. The future direction of Preventive Cardiology
for our nation rests on educating children to adopt and maintain healthy lifestyles.
The Bogalusa Heart Study has made a major contribution in providing the background
information for that direction.