ABSTRACT
University, School of Sports Science, Exercise, UK and Health, The University of Western Australia, Australia
3.1 ATHEROSCLEROSIS AS A DISEASE OF CHILDHOOD AND THE
IMPORTANCE OF PREVENTION There is now broad acceptance that the prevalence of overweight/obesity, insulin resistance and type 2 diabetes is increasing in highly urbanised western countries and, in particular, in lower socioeconomic postal ("zip") codes. There are also data emerging from China and India, populous countries with a burgeoning "middleclass", which suggest very large increases in the levels of childhood and adolescent obesity and diabetes. These data have led to some dire predictions. For example, a Special Report published in the New England Journal of Medicine concluded that: "Unless population-level interventions to reduce obesity are developed, the steady rise in life expectancy observed in the modern era may soon come to an end and the youth of today may, on average, live less healthy and possibly even shorter lives than their parents" (Olshansky et al., 2005). It is fair to say that, because clinical manifestations typically emerge in latter decades of life, atherosclerosis has traditionally been perceived as a disease of older people. However, evidence derived from autopsy studies performed in US personnel who died in the Korean war indicated that ~80% of 22 year olds had some evidence of coronary atherosclerosis. A more recent study endorsed this proportion and added that 20% of relatively young individuals (mean 26 yrs) had >50%, and ~10% had >75%, coronary stenoses. Intravascular ultrasound studies also suggest that atherosclerosis begins at a young age and other studies have reported that neonates who are small for their gestational age exhibit aortic thickening, suggesting a role for foetal programming in atherogenesis. Taken together, these data suggest that atherosclerosis begins early in life and that preventative measures should be focussed on young subjects who are at elevated risk.
