Maybe it’s time to bring Junior in for a heart check-up.

Heart attacks are vanishingly rare in kids and adolescents, but a growing body of literature suggests that the seeds of heart problems later in life are sewn in this age group. Two studies published recently in Circulation lend further credence to this idea.

In the first of these, Markus Juonala and colleagues at Finland’s Turku University Hospital followed a cohort of 4,380 people from a very young age through their 40s, and found that high systolic blood pressure, high cholesterol levels and a high body mass index in—get this—kids as young as age 9 are strong predictors of arterial wall thickening more than 3 decades later. This thickening is good non-invasive evidence of arteriosclerosis, the proximate cause of heart attacks and strokes.

Interestingly, Juonala’s group found that the presence of these risk factors at either age 3 or age 6 did not have a similar predictive value for problems later in life.

The second study, by Mika Kähönen and colleagues of Tampere University Hospital (also in Finland) used a similar longitudinal design. This group essentially proved that what your mother has been telling you all these years is correct: kids who ate fruits and vegetables at least once per day turned out to have healthier arteries when they became young adults than those who consumed these heart healthy foods twice a month or less.

Both studies relied on an arterial pulse wave velocity test to assess arterial wall thickening.

The results of these studies support many earlier ones which have indicated that all those well-established cardiac risk factors start kicking-in between the ages of 8 and 10. And yes, they do suggest it might not be a bad idea to get Junior checked for cardiac risk factors about the time he enters 4th grade.

The visit might include a blood pressure check, a cholesterol test, an assessment of the body mass index and a careful history covering exercise, diet and exposure to second-hand cigarette smoke. That said, it’s essential to seek guidance on the meaning of this visit from your doctor, since norms for these tests and historical factors aren’t as well established for kids as they are for adults.

Australian scientists have found a correlation between the time spent watching TV and all cause mortality. What is more, the relation holds even among people who exercise regularly. The problem, it seems, is prolonged inactivity.

To reach this surprising conclusion, David Dunstan of Melbourne’s Baker Heart and Diabetes Institute followed 8,800 people who were at least 50 years of age for 6 years. 284 of them died during the study, including 125 from cancer and 87 from cardiovascular disease.

Dunstan found that all cause mortality risk increased by 11% for each hour watching TV per day. The findings held up after adjustments were made for exercise duration, gender, age and waist circumference.

People who watched TV at least 4 hours per day were 46% more likely to die of any cause and 80% more likely to die of cardiovascular disease than those who watched 2 hours per day or less.

“It’s not the sweaty type of exercise we’re losing,” Dunstan told the Wall Street Journal. “It’s the incidental moving around…utilizing muscles that [doesn't happen] when we’re plunked on a couch in front of a television.”

The findings likely apply to other sedentary activities like sitting in front of a computer, driving or reading.

“The implication of these findings is that the extraordinary amount of sitting can undo the good effects that we know are a benefit when we get regular exercise,” Dunstan told the Journal.

A recent study by Neilson Co. found that Americans watch 5 hours of TV per day, on average.

Simple strategies to combat the problem include incorporating household chores like folding laundry into TV-time or (god forbid) getting up to change a TV channel rather than using a clicker.

The article appears in Circulation.

Last summer, the American Academy of Pediatrics caused a stir by recommending for the first time, statins as first-line cholesterol-lowering drugs for kids in whom weight loss and exercise failed to do the trick.

How could they do that when no one’s sure statins are safe in kids?

That’s still a matter of debate, which is why the recent research by Earl Ford and colleagues at the CDC adds some reassuring context.

These scientists matched the Academy guidelines against actual prevalence data for high cholesterol levels in this age range and determined that only 0.8% of kids between 12 and 17 qualify for the drugs.

That’s about 200,000 adolescents nationwide. The study appears in Circulation.

Academy guidelines say cholesterol-lowering drugs can be considered for children with LDL (bad) cholesterol levels in excess of 190 mg/dL, or levels in excess of 160 mg/dL if cigarette smoking, hypertension, obesity or a positive family history is present.

Children with diabetes and LDL over 130 mg/dL also qualify according to Academy guidelines.

The scientists examined data from the National Health and Nutrition Examination Survey. They found 2,724 adolescents in whom LDL values were available and 9,868 participants aged 6-17 years in whom a total cholesterol value was available.

It turned out that only 26 participants qualified for drug treatment according to Academy guidelines. Eleven of these had LDLs greater than 190, while 15 had a risk factor plus an LDL level higher than 160 mg/dL.

Only one subject was actually taking a cholesterol-lowering drug. 

Then again, it’s “a matter of opinion whether…0.8% is a small or large percentage,” Ford told MedPageToday.