When Should Prevention Start? Promoting Cardiovascular Health Across The Lifecourse

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​Valerie Swanson, MPH-c

​Wei Perng, MPH, PhD

Cardiovascular disease (CVD), a term that encompasses a number of conditions comprising any heart or blood vessel disorder, is the leading cause of premature death in the U.S., accounting for 1 in 4 deaths. Despite a growing focus on optimizing and promoting health in American culture, the implementation of policies, initiatives, and guidelines targeting CVD over the last half-century have been insufficient to meet the challenges of the growing burden. Between 2015 and 2018, 49.2% (126.9 million) of American adults had CVD, with direct and indirect costs of the disease reaching $555 billion in 2016 alone. The American Heart Association (AHA) projects annual direct and indirect costs to reach over $1 trillion by 2035.

CVD is preventable. As CVD is preventable, the AHA established the ideal cardiovascular health (ICVH) construct, or Life’s Simple 7, to guide cardiovascular health promotion. Four of the included metrics are biological factors: normal blood pressure, total cholesterol, blood glucose, and body mass index (BMI). The remaining three are health behaviors: no smoking, adequate physical activity, and healthy diet. This construct is associated with lower risk of CVD as well as decreased morbidity and mortality. Yet, the exceedingly low prevalence (<1%) revealed in population-based studies of adults highlights the need to promote ICVH earlier in the lifecourse.
Primordial prevention of CVD during early-life is key. To date, the popular approach to preventing CVD has been primary prevention, or the prevention of disease following the development of risk factors. Given that cardiovascular profile (factors include excess adiposity, dyslipidemia, elevated blood pressure) is established during the first decade of life, primordial prevention, or the early promotion of health in order to prevent development of risk factors, is key to reversing current CVD trends. In the Colorado-based Healthy Start Study, only 7% of children aged 4-5 years had ICVH, with the limiting factors being diet and physical activity, demonstrating how crucial it is to promote and maintain ICVH in young children.
Current literature on ICVH in pediatric populations is limited. The majority of studies on ICVH in youth are in older children and adolescents (10-18 years old), which may hamper identification of even earlier developmentally-plastic life stages when CVD risk factors and precursors are established. Further, it is vital to assess change in prevalence of ICVH in youth given that health behaviors and cardiovascular risk biomarkers may fluctuate across development, and little is known regarding whether these fluctuations have implications on long-term disease risk.
What can be done? Evidence suggests a strong maternal influence on young children’s eating patterns. As dietary habits are established in childhood, it is important for healthcare providers to communicate regularly with caregivers to promote healthy eating and physical activity habits at a young age. This can include traditional approaches such as counseling or education, partnered with more novel approaches such as digital interventions and/or telephone coaching beginning early in pregnancy and continued at each annual well-child visit. Schools also have a unique opportunity to establish healthy habits, given that children consume up to 50% of their daily calories in this setting. Finally, local efforts to promote ICVH at school can target healthy individual biological and behavior metrics through adding programs such as nutritious food preparation and daily classroom physical activity opportunities before, during, and after the school day.