Heart-Health Tips for Families
February is heart month. Families can practice heart-healthy lifestyle tips to ensure that they set their kids up with the best practices in maintaining cardiovascular health throughout their lives. To learn more, we spoke with Michael Fremed, MD, Pediatric Cardiologist of NewYork-Presbyterian/Columbia University Irving Medical Center and NewYork-Presbyterian Morgan Stanley Children’s Hospital. Dr. Fremed shared more about heart health, common heart issues in kids, how to stay healthy as a family, and much more!
Westchester Family: Why do you think many heart issues go unnoticed?
Michael Fremed, MD: This differs in children and adults because the types of heart conditions each of these populations experience are different. For adults, heart issues may go unnoticed because they are initially “silent.” This means there are no obvious symptoms present, or symptoms are subtle. Additionally, it is easy to attribute them to other common and less serious conditions such as “heartburn” or physical deconditioning. For some people, a lack of consistent health care maintenance visits with their primary provider may lead to delayed detection of some conditions.
Westchester Family: Why are some common heart issues in kids?
Michael Fremed, MD: In children, many types of congenital heart disease or abnormal heart rhythms may also be asymptomatic at first or may never develop symptoms. Some of these don’t manifest abnormalities until later in childhood or adolescence. Many of these can be considered “minor” abnormalities, or ones that are not likely to cause significant issues even if detection is delayed. Additionally, some of these are more serious and can potentially be fatal if not detected and managed properly.
This is part of why regular healthcare maintenance visits and pre-participation screening in the primary care setting is so important as it can identify red flags that merit additional evaluation by a cardiologist prior to engaging in sports and other types of physical activity. For example, the pediatrician may notice a drop off in weight related to poor feeding in a baby, a new heart murmur, or something on the patient’s personal or family history that merits additional investigation.
One great tool that has been in use for some time is the AHA 14 element screen. This is intended for middle school and high school athletes prior to sports participation. Recently, the AAP has endorsed a simplified, four question screen for all children regardless of sports participation status in addition to the 14 element screen for athletes, in order to cast a wider net in catching subtle red flags that merit further evaluation by a pediatric cardiologist. Thankfully, most children do not end up having heart disease and can safely participate in activities.
Westchester Family: What are some common heart issues in men/women?
Michael Fremed, MD: Cardiovascular disease is common in adults and heart disease remains the number one cause of death in both men and women. This often starts more peripherally with hypertension and high cholesterol. Both of which contribute to atherosclerosis (thickening or hardening of the arteries) build up including in the coronary and carotid arteries. This can lead to heart attacks and strokes. Congestive heart failure in which the heart doesn’t pump as well as it should. This leads to fluid buildup in the lungs and body. This can also lead to abnormal heart rhythms in older age. Cardiovascular disease is relatively common among adult. This includes conditions such as atherosclerosis and coronary artery disease, which can cause heart attacks, carotid artery disease. This can lead to stroke and hypertension.
In children, congenital heart disease is more common (though still overall rare) than the acquired heart disease of adulthood. This is because they have not had enough time to develop the issues that come with prolonged exposure to high blood pressure and fatty plaque buildup in the arteries.
Westchester Family: How can families incorporate healthy heart habits at home?
Michael Fremed, MD: Lifestyle modifications are best achieved when it is done as a team sport. Families can help each other stay healthy by eating more home cooked meals together. This can include whole grains, fruits, vegetables, lean proteins and healthy fats. Additionally, focus on meals that are low in added sugar. Increasing plant-based foods in the diet also has tremendous benefits as well. Cooking with your kids is a great way to engage them about making healthy choices. This also gets them excited about eating different foods.
Eating healthy is only one component though, physical activity is also critical. The more movement families can incorporate into their daily routines the better. Even if it’s only a few minutes at a time. Any active minutes are better than no active minutes. As a working parent of three young children, I know how challenging it can be to fit in traditional workouts. This is where it is helps to find creative ways to include your kids in your exercise routines. In my house that means dancing to music while cleaning up the kitchen after dinner and taking the baby on a run in the stroller for her naptime. Most parents of young children get more exercise than they realize just from the daily routines of parenting. All of this movement counts!
Westchester Family: What are some realistic goals families can make?
That isn’t to say that all treats and “fun” snacks need to be eliminated. Kids can eat them in moderation. Additionally, parents shouldn’t be forcing their inactive child to become a competitive athlete overnight. When I counsel patients and families on making healthy changes, I emphasize picking small, achievable goals to start. This is preferably one food related (such as decreasing add-sugar beverages) and one movement related (taking some stairs instead of elevator when possible). Once those become part of the normal routine, then they can add new goals.
Westchester Family: How does anxiety impact heart health in adults?
Michael Fremed, MD: Mental health issues including anxiety can exacerbate physical conditions, including heart health, in both direct and indirect ways. Anxiety can create prolonged states of high blood pressure. This causes damage to the blood vessels and can increase development of atherosclerosis. Also, called fatty plaques in the walls of those vessels. This can ultimately can lead to heart attacks and/or strokes.
Indirectly, anxiety leads to other unhealthy habits. This can include poor food choices, poor sleep, decreased exercise, and in some cases substance use. Anxiety can also negatively impact how physical symptoms are experienced by the individual and make them that much more challenging to cope with.
Westchester Family: What are some ways kids can be heart healthy?
Michael Fremed, MD: Although children are unlikely to get heart attacks, we know that the precursors to heart attacks and heard disease of adulthood begin to develop in childhood, even as young as age 10. Though much of this is related to obesity, weight alone is not a perfect indicator of heart health. Some who is overweight but physically active may be in better cardiovascular shape than someone who is thin but sedentary (inactive). Promoting good food choices and physical activity from an early age can make it easier to maintain a healthy lifestyle as they get older.
Parents can also stick to the recommended healthcare maintenance and vaccination schedules where screenings are performed. This includes vital sign checks, blood work to check cholesterol levels, and screening questions to assess risk for heart problems. Similarly, though it may seem unrelated, kids need good dental hygiene with regular trips to the dentist. This helps maintain heart health as tooth and gum disease increases risk of heart infections and cardiovascular disease.
Westchester Family: How does poor sleep impact heart health?
Michael Fremed, MD: Most of us can think of a time when we stayed up way too late. When we are tired we tend to crave high fat. Additionally, we crave high sugar, nutritionally poor foods as a form of quick and delicious energy. Sleep deprivation can increase stress and trigger increased production of cortisol (stress hormone). This increases blood pressure and ultimately a risk for cardiovascular disease. Being tired also makes you feel more sluggish during the day. This, in turn, means you are less likely to be physically active. I see many teenagers in the office for dizziness or changes in exercise tolerance, and frequently poor sleep is contributing to these symptoms.
For a subset of people, poor sleep may be a result of certain health conditions. It is important to see your doctor if you are unable to sleep well, snore at night, or often feel tired during the day despite what seems like a normal amount of sleep. One of these conditions is sleep apnea, in which the individual intermittently stops breathing during sleep. Though not primarily a heart issue, it can cause different types of heart issues. This includes high pressures in the heart chambers, abnormal conduction of the electrical signals of the heart known as “heart block.”
Additionally, this can lead to an increased risk of congestive heart failure and heart attacks. Thankfully, this condition is typically treatable with airway pressure device. However, some people, often children, benefit from surgery to remove enlarged tonsils and adenoids if that is felt to be contributing to the condition.
Westchester Family: What does having a healthy heart mean over the years?
Michael Fremed, MD: Maintaining a healthy heart over your lifetime means feeling better and having the energy to enjoy the things in life that you want to enjoy. For parents, having a healthy heart means being able to be more present and active for your children. Leading a heart healthy lifestyle as an adult can help create positive associations with heart health in children.
