Claudia Montanaro
Royal Brompton Hospital, London, UK
Title: Cardiovascular risk in adolescents and exercise issues in the congenital heart disease population.
Biography
Biography: Claudia Montanaro
Abstract
In 2009 in the European Union the costs related to cardiovascular diseases amounted to E106 billion, representing ~9% of the total expenditure on healthcare[i]. The scientific community has allocated significant funds to identify behaviour in the young which might adversely affect health in adult life. Based on the American Heart Association guidelines, the ideal cardiovascular health(iCVH) construct[ii] consists of 4 ideal health behaviors (nonsmoking, BMI <25 kg/m2, physical activity at goal level, and diet consistent with current recommendations) and 3 ideal health factors (untreated total cholesterol <200 mg/dL, untreated BP <120/<80 mmHg, and untreated fasting glucose <100 mg/dL). Adolescents from a high socio-economic class are more likely to have a healthy diet, high levels of physical fitness and consequently lower cardiovascular risk[iii]. Only 47% of U.S. adolescents and 54% of European adolescents exhibit at least 5 of the 7 iCVH components[iv] [v]. Scientific literature shows that psychological and biological factors, social environment and community settings play an important role in the adolescent’s habits. Healthy habits and good physical activity is paramount for these patients. In the past, all patients with CHD were excluded from competitive sports mainly because of the risk of sudden death (SD). It has been noted that sudden death in CHD patients is generally rare. Aerobic activity and sport in general should always be recommended; there are exceptions as patients with severe left and/or right outflow tract obstructions, failing Senning or Mustard repairs, severe pulmonary hypertension, bicuspid aortic valve with severe aortic dilation and particular cases of anomalous coronary artery, in which it is reasonable to discourage competitive sports. Nowadays, available tools to estimate the risk of SD are appropriate interpretation of ECG, fibrosis evaluation with cardiac magnetic resonance and cardiopulmonary exercise test.
Patients with congenital heart disease should be cared for in a tertiary centre where high level of expertise and knowledge informs any ad hoc counselling based on objective and self-perceived patient capacity and potentiality
[i] 2016 European Guidelines on cardiovascular disease prevention in clinical practice (The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) European Heart Journal (2016) 37, 2315–2381
[ii] Lloyd-Jones DM, Hong Y, Labarthe D et al. Defining and setting national goals for
cardiovascular health promotion and disease reduction: the American Heart Association's
strategic Impact Goal through 2020 and beyond. Circulation. 2010;121:586-613.
[iv] Shay CM, Ning H, Daniels SR, Rooks CR, Gidding SS, Lloyd-Jones DM. Status of cardiovascular health in US adolescents: prevalence estimates from the National Health and Nutrition Examination Surveys (NHANES) 2005-2010. Circulation. 2013;127:1369-76.
[v] Pontus Henriksson, Hanna Henriksson, Luis Gracia-Marco, Idoia Labayen, Francisco B Ortega, Inge Huybrechts, Vanesa España-Romero, Yannis Manios, Kurt Widhalm, Jean Dallongeville, Marcela Gonzalez-Gross, Ascension Marcos, Luis A Moreno, Manuel J Castillo, Jonatan R Ruiz, on behalf of the HELENA study group3Prevalence of ideal cardiovascular health in European adolescents: The HELENA Study
[1] 2016 European Guidelines on cardiovascular disease prevention in clinical practice (The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) European Heart Journal (2016) 37, 2315–2381
[1] Lloyd-Jones DM, Hong Y, Labarthe D et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond. Circulation. 2010;121:586-613.
[1] Shay CM, Ning H, Daniels SR, Rooks CR, Gidding SS, Lloyd-Jones DM. Status of cardiovascular health in US adolescents: prevalence estimates from the National Health and Nutrition Examination Surveys (NHANES) 2005-2010. Circulation. 2013;127:1369-76.
[1] Pontus Henriksson, Hanna Henriksson, Luis Gracia-Marco, Idoia Labayen, Francisco B Ortega, Inge Huybrechts, Vanesa España-Romero, Yannis Manios, Kurt Widhalm, Jean Dallongeville, Marcela Gonzalez-Gross, Ascension Marcos, Luis A Moreno, Manuel J Castillo, Jonatan R Ruiz, on behalf of the HELENA study group3Prevalence of ideal cardiovascular health in European adolescents: The HELENA Study