Catch them young: school program to reduce cardiovascular disease

By Dr. Liji Thomas, MDSep 23 2019

Children rarely get heart attacks – but the way their habits develop can play a crucial role in reducing their future chances of having heart disease. A new study presented at the Brazilian Congress of Cardiology (SBC 2019) on September 21, 2019, shows that school projects encouraging a better diet and more activity can reduce such deaths.

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Cardiovascular disease

Ischemic heart disease is due to the blocking of arteries by fatty calcium-rich deposits on the blood vessel walls. These eventually bulge so far into the space within the blood vessel that they block the flow of blood, cutting off circulation to the heart muscle itself. As a result, a part of the heart muscle begins to die, causing a classic heart attack.

In other cases, the pounding of the blood against this brittle bulging deposit can cause part of it to break off, or to form a clot in its lee. The clot can also break off, and these traveling pieces of solid material within the bloodstream are potential bombs. As they are carried deeper and deeper into the circulation, they enter narrower arteries, until they are finally arrested in a tiny vessel, cutting off circulation abruptly and completely to that part of the organ. Many strokes occur this way, as do lung embolisms. All these conditions are termed cardiovascular disease (CVD).

CVD is the leading cause of death in the world. Almost 18 million people die this way each year, including 370,000 people in Brazil. While there was an initial reduction in the risk of death from CVD in Brazil, this decline has now evened out, suggesting that medical intervention has reached its limit of tertiary prevention (preventing death after the onset of CVD).

Over 50% of Brazilians are too plump for health, says Dalton Précoma, chair of the scientific sessions at SBC 2019. It is estimated that about 3.2 million people would have lived longer if they had been physically active. Thus the Brazilian Society of Cardiology (SBC) launched its Goes to School project to target children who are on this self-destructive path – before it becomes too late.

According to the World Health Organization (WHO), there are about 41 million obese or overweight children and infants in the world today. Just two years ago, the number stood at 32 million.

Children on the path to danger

The SBC Goes to School project will teach 3,000 teachers and pupils about heart health, at first. These people, called “monitors”, will then pass it on to 63 000 more students between the ages of 6 and 18 students from about 210 public schools in Sao Paulo, a state of Brazil.

The first session will be inaugurated on School Heart Day, September 25 2019, after a baseline assessment of their diet and activity. The teaching will look at how seven factors increase the individual’s chances of developing CVD. These are: lack of physical activity, smoking and/or drug use, obesity, high cholesterol levels, diabetes, high blood pressure, and stress. On the other hand, a healthy diet and being regularly active protect against CVD. Thus the emphasis will be on helping schools to increase the percentage of children who eat well and exercise properly. The actual teaching and health promotion activities will involve cardiologists, nursing staff, teachers and psychologists.

The report presented at the congress is that of the pilot project, covering 433 students, both male and female in equal proportions. The average age was 13 years. The baseline activity level was 40, 60 and 60 minutes a week of mild, moderate and vigorous activity. In contrast, they sat for around 360 minutes a week. In contrast, the WHO recommends 300 minutes a week of physical activity in children and adolescents, which is significantly above the baseline activity levels in the Brazilian study.

Researcher Karine Turke comments, “Modern lifestyles promote interaction by mobile phone and video games. There is less security on the streets so children cannot play outside. The program encourages less sedentary time and finding ways to move around more.”

The baseline food survey which covered the food eaten the day before the study found that over 90% of children ate rice or starch in some form; 70% had pulses; almost 70% ate fruit; about 80% had meat (red or white); approximately 50% of children had leafy vegetables; the same for any candy; and about 40% each responded “Yes” to soft drinks, chocolate, reconstituted powdered beverages and sausages. They noted a high percentage of processed foods, which is likely to be the result of ease of preparation compared to cooking from scratch using fresh food.

In the project, the students will also learn to distinguish four categories of foods: fresh, minimally processed, processed, and ultra-processed. They will also be able to choose to eat foods that have not been or only minimally processed.

Putting it all together

Précoma says that moderate to vigorous activity is essential every single day in adolescents and young children, with less time spent sitting. This requires parents to cooperate in creating such an atmosphere, as well as to model healthy behavior themselves in their food choices, shopping, and activity levels. Eating meals together, not skipping breakfast, and leaving out junk foods are all steps that build healthy lifestyle habits for the rest of their lives.

Carlos Aguilar, the European Society of Cardiology (ESC) course director at SBC 2019, agrees: “Improving lifestyles in children is a collective responsibility.” He specifically names instances such as legal restrictions on targeting children while marketing junk foods and sweet beverages, making fresh drinking water and healthy food available at school and vending machines, and providing activity breaks during school hours. He adds: “Communities need parks and playgrounds. These efforts and others should go a long way to reducing cardiovascular events in the long run.”

Turke sums up, “Advocating the choice of healthy foods and greater activity is essential to halt the obesity crisis in Brazil and worldwide and stop needless deaths from heart attack and stroke.”