Children with risk factors for atherosclerosis such as hypertension, obesity, diabetes and high cholesterol levels are likely to already have signs of arterial plaque formation, according to a presentation at the annual meeting of the American Heart Association.

“Primary prevention of heart disease must start in childhood,” said Sanaz Piran, MD, internal medicine resident at McMaster University in Hamilton, Ontario, Canada. “We need to start looking at and treating risk factors for heart disease in children.”

In the current study, researchers reviewed 26 studies from the United States, the Netherlands, Australia, Finland, Norway and Italy that used noninvasive methods to measure the thickness of arterial walls and blood flow in children without risk factors, as well as in children with risk factors for cardiovascular disease.

In three studies, ultrasound was used to measure carotid artery intima-media thickness (CIMT). Children with risk factors for heart disease and stroke had an average of 8.7 percent more thickening than children without risk factors.

Another noninvasive test - brachial or femoral artery flow-mediated dilation (FMD) - showed an average 37-percent decreased blood flow in children with risk factors compared to those without them. Flow-mediated dilatation, the flow of blood either in the arm or thigh is gauged with ultrasound after a cuff is inflated and deflated. The test is a validated measure of early atherosclerosis.

“These results indicate structural abnormalities and artery wall dysfunction, both signs of the early stages of atherosclerosis,” Piran said. “Children with risk factors are showing the markers for sub-clinical atherosclerosis.”

The 26 studies included 3,630 children age 5 to 18 years and compared healthy children to children with cardiovascular risk factors. In 15 studies, researchers measured wall thickness and flow-mediated dilation in 8 studies.

Twelve of 15 studies showed that artery wall thickness was higher in children with risk factors. All eight studies testing flow-mediated dilation showed that subgroups of children with risk factors had reduced arterial function. Three other ultrasound studies showed that children with risk factors were more likely to have arterial stiffness in neck arteries.

“The very things we recommend to adults should be recommended to parents for their children,” Piran said. “There needs to be a family-oriented approach to cardiovascular prevention and to addressing these risk factors.”