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Letter from the editor: an ounce of prevention is worth a pound of cardiac imaging
Seminars in Roentgenology VOL 38, NO 4
OCTOBER 2003
Letter From the Editor: An Ounce of Prevention Is Worth a Pound of Cardiac Imaging
A
THEROSCLEROSIS BEGINS in children and the extent of early arterial involvement is strongly associated with low-density lipoprotein cholesterol levels.1 When started in childhood, diets restricted in components that elevate LDL cholesterol (saturated fat and cholesterol) have the long-term potential to decrease the frequency of coronary artery disease and the extent of clinical disease later in adulthood. Children in the United States today are less fit than they were a generation ago. Many are showing early signs of cardiovascular risk factors such as physical inactivity, excess weight, higher blood cholesterol, and cigarette smoking.2 At least half of youth do not engage in physical activity that promotes long-term health, less than 36% of elementary and secondary schools offer daily physical education classes, and most classes are unlikely to foster lifelong physical activity.2 Inactive children are likely to become inactive adults. Eleven percent of males age 12 to 17 and 9.9% of females the same age are overweight, and about 10% of adolescents age 12 to 19 have total cholesterol levels exceeding 200 mg/dL.2 It is estimated that 3,000 American young people become smokers every day.2 Obesity in childhood lays the metabolic groundwork for adult cardiovascular disease.3 Thirtythree percent of the US population is obese, and obesity is an independent risk factor for coronary atherosclerosis.4 Diets high in fat (and calories) and a reduced expenditure of energy in the form of physical activity are the most likely explanations.5,6 No matter what the therapeutic approach, obesity recidivism is common, with ⬍5% of patients maintaining their reduced weight at 4 years.7 Thus, therapeutic regimens must be maintained indefinitely; even then, only surgery has been proved to produce substantial sustained long-term
© 2003 Elsevier Inc. All rights reserved. doi:10.1053/S0037-198X(03)00051-8
weight loss.4 Prevention of obesity by diet and regular physical activity remains the highest priority for maintaining cardiovascular health. This is particularly important for small children and adolescents. According to the lead author of an American Heart Association scientific statement, “Physical activity as a treatment is under-recommended by physicians.”8 The American Heart Association advocates 30 minutes or more of moderate-intensity exercise, such as brisk walking, on most and preferably all days of the week, as recommended by the Centers for Disease Control and Prevention and the American College of Sports Medicine.8 The statement also recommends that physicians and other health care providers become physically active so they can be role models; use their influence as community members to encourage schools to develop physical education programs that encourage maintaining physically active lifestyles; include patients’ physical activity as part of their medical history; provide an exercise prescription for patients; encourage patients to engage in a variety of physical activities; and advocate exercise in their communities by encouraging an environment in which people can exercise easily, including bike and walking paths, safe routes to walk to school, and gymnasiums open in the evening. Most studies showing the positive effects of exercise have been done with men. However, the few studies that have included women have shown that women may benefit even more than men from being physically fit, and physically fit women enjoy even greater reduced rates of death from heart disease than men.9 Aside from reducing the risk of heart disease by improving blood circulation throughout the body, daily physical activity keeps weight under control; improves blood cholesterol levels; prevents and manages high blood pressure; prevents bone loss; boosts energy level; helps manage stress; releases tension; improves the ability to fall asleep quickly and sleep well; improves self-image; counters anxiety and depression
Seminars in Roentgenology, Vol 38, No 4 (October), 2003: pp 291-292
291
292
JANNETTE COLLINS
and increases enthusiasm and optimism; increases muscle strength, increasing the ability to do other physical activities; provides a way to share an activity with family and friends; establishes good heart-healthy habits in children and counters the conditions that lead to heart attack later in life; and in older people, helps delay or prevent chronic illnesses and diseases associated with aging and maintains quality of life and independence longer.10 Dr Reddy has assembled a group of talented
authors to write about the current state of and future advancements in cardiac imaging with computed tomography and magnetic resonance imaging. Clearly, these 2 imaging modalities will continue to play an ever-enlarging role in the screening, diagnosis, and treatment of cardiovascular disease. I thought I would offer a prologue on prevention before you get to the diagnosis and cure. Jannette Collins, MD, MEd, FCCP Editor
REFERENCES 1. Fisher EA, Van Horn L, McGill HC: A statement for healthcare professionals from the nutrition committee, American Heart Association. Circulation 95:2332-2333, 1997 2. American Heart Association. Children’s need for physical activity: fact sheet. Available at: http://www.americanheart.org/ presenter.jhtml?identifier⫽771. Accessed July 21, 2003 3. Gidding SS: A perspective on obesity. Am J Med Sci 310:S68-71, 1995 (suppl) 4. Eckel RH: A statement for healthcare professionals from the nutrition committee, American Heart Association. Circulation 96:3248-3250, 1997 5. Lissner L, Heitmann BL: Dietary fat and obesity: Evidence from epidemiology. Eur J Clin Nutr 49:79-90, 1995 6. Williamson DF, Madans J, Anda RF, et al: Recreational
physical activity and ten-year weight change in a US national cohort. Int J Obes 17:279-286, 1993 7. Kramer FM, Jeffery RW, Forster JL: Long-term follow-up of behavioral treatment for obesity: patterns of weight regain among men and women. Int J Obes 13:123-136, 1989 8. American Heart Association Statement 6/24/03. Available at: http://www.americanheart.org/presenter.jhtml?identifier⫽ 3013011 Accessed July 22, 2003 9. American Heart Association. Physical activity and cardiovascular health: questions and answers. Available at: http:// www.americanheart.org/presenter.jhtml?identifier⫽830 Accessed July 22, 2003 10. American Heart Association. The benefits of daily physical activity. Available at: http://www.americanheart.org/ presenter.jhtml?identifier⫽764 Accessed July 22, 2003
OCTOBER 2003
Letter From the Editor: An Ounce of Prevention Is Worth a Pound of Cardiac Imaging
A
THEROSCLEROSIS BEGINS in children and the extent of early arterial involvement is strongly associated with low-density lipoprotein cholesterol levels.1 When started in childhood, diets restricted in components that elevate LDL cholesterol (saturated fat and cholesterol) have the long-term potential to decrease the frequency of coronary artery disease and the extent of clinical disease later in adulthood. Children in the United States today are less fit than they were a generation ago. Many are showing early signs of cardiovascular risk factors such as physical inactivity, excess weight, higher blood cholesterol, and cigarette smoking.2 At least half of youth do not engage in physical activity that promotes long-term health, less than 36% of elementary and secondary schools offer daily physical education classes, and most classes are unlikely to foster lifelong physical activity.2 Inactive children are likely to become inactive adults. Eleven percent of males age 12 to 17 and 9.9% of females the same age are overweight, and about 10% of adolescents age 12 to 19 have total cholesterol levels exceeding 200 mg/dL.2 It is estimated that 3,000 American young people become smokers every day.2 Obesity in childhood lays the metabolic groundwork for adult cardiovascular disease.3 Thirtythree percent of the US population is obese, and obesity is an independent risk factor for coronary atherosclerosis.4 Diets high in fat (and calories) and a reduced expenditure of energy in the form of physical activity are the most likely explanations.5,6 No matter what the therapeutic approach, obesity recidivism is common, with ⬍5% of patients maintaining their reduced weight at 4 years.7 Thus, therapeutic regimens must be maintained indefinitely; even then, only surgery has been proved to produce substantial sustained long-term
© 2003 Elsevier Inc. All rights reserved. doi:10.1053/S0037-198X(03)00051-8
weight loss.4 Prevention of obesity by diet and regular physical activity remains the highest priority for maintaining cardiovascular health. This is particularly important for small children and adolescents. According to the lead author of an American Heart Association scientific statement, “Physical activity as a treatment is under-recommended by physicians.”8 The American Heart Association advocates 30 minutes or more of moderate-intensity exercise, such as brisk walking, on most and preferably all days of the week, as recommended by the Centers for Disease Control and Prevention and the American College of Sports Medicine.8 The statement also recommends that physicians and other health care providers become physically active so they can be role models; use their influence as community members to encourage schools to develop physical education programs that encourage maintaining physically active lifestyles; include patients’ physical activity as part of their medical history; provide an exercise prescription for patients; encourage patients to engage in a variety of physical activities; and advocate exercise in their communities by encouraging an environment in which people can exercise easily, including bike and walking paths, safe routes to walk to school, and gymnasiums open in the evening. Most studies showing the positive effects of exercise have been done with men. However, the few studies that have included women have shown that women may benefit even more than men from being physically fit, and physically fit women enjoy even greater reduced rates of death from heart disease than men.9 Aside from reducing the risk of heart disease by improving blood circulation throughout the body, daily physical activity keeps weight under control; improves blood cholesterol levels; prevents and manages high blood pressure; prevents bone loss; boosts energy level; helps manage stress; releases tension; improves the ability to fall asleep quickly and sleep well; improves self-image; counters anxiety and depression
Seminars in Roentgenology, Vol 38, No 4 (October), 2003: pp 291-292
291
292
JANNETTE COLLINS
and increases enthusiasm and optimism; increases muscle strength, increasing the ability to do other physical activities; provides a way to share an activity with family and friends; establishes good heart-healthy habits in children and counters the conditions that lead to heart attack later in life; and in older people, helps delay or prevent chronic illnesses and diseases associated with aging and maintains quality of life and independence longer.10 Dr Reddy has assembled a group of talented
authors to write about the current state of and future advancements in cardiac imaging with computed tomography and magnetic resonance imaging. Clearly, these 2 imaging modalities will continue to play an ever-enlarging role in the screening, diagnosis, and treatment of cardiovascular disease. I thought I would offer a prologue on prevention before you get to the diagnosis and cure. Jannette Collins, MD, MEd, FCCP Editor
REFERENCES 1. Fisher EA, Van Horn L, McGill HC: A statement for healthcare professionals from the nutrition committee, American Heart Association. Circulation 95:2332-2333, 1997 2. American Heart Association. Children’s need for physical activity: fact sheet. Available at: http://www.americanheart.org/ presenter.jhtml?identifier⫽771. Accessed July 21, 2003 3. Gidding SS: A perspective on obesity. Am J Med Sci 310:S68-71, 1995 (suppl) 4. Eckel RH: A statement for healthcare professionals from the nutrition committee, American Heart Association. Circulation 96:3248-3250, 1997 5. Lissner L, Heitmann BL: Dietary fat and obesity: Evidence from epidemiology. Eur J Clin Nutr 49:79-90, 1995 6. Williamson DF, Madans J, Anda RF, et al: Recreational
physical activity and ten-year weight change in a US national cohort. Int J Obes 17:279-286, 1993 7. Kramer FM, Jeffery RW, Forster JL: Long-term follow-up of behavioral treatment for obesity: patterns of weight regain among men and women. Int J Obes 13:123-136, 1989 8. American Heart Association Statement 6/24/03. Available at: http://www.americanheart.org/presenter.jhtml?identifier⫽ 3013011 Accessed July 22, 2003 9. American Heart Association. Physical activity and cardiovascular health: questions and answers. Available at: http:// www.americanheart.org/presenter.jhtml?identifier⫽830 Accessed July 22, 2003 10. American Heart Association. The benefits of daily physical activity. Available at: http://www.americanheart.org/ presenter.jhtml?identifier⫽764 Accessed July 22, 2003