Cardiovascular health programs will need to shift focus to include not only youths but a greater emphasis on women as well.

Like healthy eating habits, heart disease prevention must start early, a landmark study shows.

In fact, although heart disease usually results in death or disability after age 50, risk factors for heart disease affect the development of atherosclerosis early in life — even before age 20, according to results of the study, supported by the National Heart, Lung, and Blood Institute (NHLBI).

"These results help settle a long-standing controversy," said Dr. Claude Lenfant, NHLBI director. It was known that the buildup of cholesterol in arteries leads to heart disease but, because of the difficulty of gathering data on children, it was not known when the buildup began to occur.

"We now know that the risk factors important in adulthood are just as crucial in children," said Lenfant.

The Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study findings also show for the first time that three risk factors — high density lipoprotein (HDL), low density lipoprotein (LDL) and smoking — affect the progression of atherosclerosis about equally in women and men, and in blacks and whites.

"PDAY's results have profound implications for heart disease prevention," said Dr. Henry McGill, senior scientist at the Southwest Foundation for Biomedical Research and lead author of the study article, published in "Arteriosclerosis, Thrombosis and Vascular Biology" journal.

"It was thought that, since heart disease deaths tend to occur 10 years later in women than men, women did not need to start preventive measures as early," McGill noted. "These data confirm that all persons — women and men, black and white — need to adopt healthful habits as soon as possible."

PDAY involved 15 centers nationwide that gathered data from autopsies of 1,079 men and 364 women, ages 15-34, who died from accident, homicide or suicide. Measurements taken included blood levels of HDL and LDL, and thiocyanate, a chemical marker for smoking. Coronary arteries were examined for the extent of cholesterol deposits and scar tissue.

Results showed dramatic and early differences in atherosclerosis between those with good risk factor profiles and those with bad profiles. Those with high HDL levels, low LDL levels and no evidence of smoking lacked severe deposits in arteries. By contrast, those with low HDL, high LDL and smoking had marked fatty streaks and deposits. The differences appeared by age 15, researchers noted.

Address: National Heart, Lung, and Blood Institute, 9000 Rockville Pike, Building 31, Bethesda, MD 20892; (301) 496-5166.

Copyright 1999 Health Resources Publishing