Hidden heart disease lurks in healthy-looking young adults

You’re thin, your cholesterol and blood pressure are good, and nobody in your family has ever had a heart attack – so you figure you must be safe from heart disease. New research suggests you could be dead wrong.

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A new study shows that a large proportion of normal weight, and apparently healthy, young people already have some thickening in their blood vessel walls. In other words, they have the beginnings of cardiovascular disease, according to a report presented at the Canadian Cardiovascular Congress in Vancouver.

“These are young adults with no known risk factors,” said the study’s lead author, Dr. Eric Larose, an assistant professor and co-director of cardiovascular magnetic resonance and computed tomography at the Quebec Heart Institute at Laval University in Quebec City. “They had no diabetes, their cholesterol levels and blood pressures were normal. And none of them were obese. They were basically the picture of good health.”

The new results may help explain the epidemic of heart attacks and stroke, Larose said, pointing to the toll cardiovascular disease takes in women.

“This year 40,000 North American women will die from breast cancer,” he explained.  “That’s compared to 400,000 women who will die of cardiovascular disease. That’s 10 times as much. It’s a huge problem.”

Unfortunately, many people may be suffering from “hidden” heart disease, Larose said. By all the standard measures they look perfectly healthy, but plaque is slowly, inexorably accumulating in their arteries.

Larose and his colleagues studied 168 healthy normal-weight volunteers aged 18 to 35. The researchers used MRI to look at the condition of volunteers’ blood vessels and also at fat that was socked away deep inside the body around the organs – also known as visceral fat.

Almost half - 48 percent - of the volunteers showed signs of blood vessel thickening, an early indication of developing cardiovascular disease.  MRI scans also showed hidden fat deposits in these seemingly thin people. And that’s what explains the thickening of the blood vessel walls, Larose said.

There was some good news in the study, though. Larose and his colleagues determined that there was a simple way to determine, without costly MRI scans, who is likely to have thickening blood vessels: all you need to do is measure a person’s waist and hips. Study volunteers with signs of incipient heart disease tended to have hips that measured almost the same as or smaller than their waists.

For these young people, there’s still a chance to diffuse the time bomb. Lifestyle changes, especially exercise, can yield dramatic improvements, Larose said.

“That doesn’t mean you have to become a marathon runner,” he added. “If you just exercise three times a week, within a year that visceral fat will literally melt away.”

Heart experts underscored the importance of the new findings and commended the researchers on the large size of the study.

It’s important to realize that these changes in the arteries begin early in life and that atherosclerosis is a chronic disease that takes years to develop, said Dr. Nehal N. Mehta, director of the Inflammatory Risk Clinic in Preventive Cardiology at the Perelman School of Medicine at the University of Pennsylvania.

That means people have time to abort the process, Mehta said. Unfortunately there are people in the early stages of cardiovascular disease who probably are flying under the radar because they look healthy.

“We measure waist to hip ratio here,” Mehta said. “But most doctors do not.”

But you don’t have to wait to see a doctor to find out if you’re at risk, Mehta said. Just take a tape measure and see how your hips compare to your waist.

“The real message here is that we’ve got to start with the youth if we really want to impact cardiovascular disease,” said Dr. Daniel Edmundowicz, director of lipid management and vascular disease prevention for the Heart and Vascular Institute at the University of Pittsburgh Medical Center. “You really don’t want to wait until someone has had a heart attack and survived and then measure their waist to hip ratio.”

The new findings also highlight the weaknesses of current screening strategies, Edmundowicz said.

“There is silent stuff going on and kids and young adults don’t know what’s happening,” he added. “That is why cardiovascular disease remains the number one killer of men and women – we’re trying to use old measures to find it.”