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Pediatric Heart News - Another Reason to Tackle Childhood Obesity

Pediatric Heart News Winter 2015

Another Reason to Tackle Childhood Obesity

Date: April 15, 2015


Shetarra Walker and Tammy Brady review images of the left ventricle from an individual with LVH. LVH precedes arrhythmias and heart failure in adults and is used as a surrogate endpoint in children for severity of cardiovascular disease. When LVH is found
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Shetarra Walker and Tammy Brady review images of the left ventricle from an individual with LVH. LVH precedes arrhythmias and heart failure in adults and is used as a surrogate endpoint in children for severity of cardiovascular disease. When LVH is found in children, it often suggests a need to escalate antihypertensive therapy. “We have found,” says Brady, “that among hypertensive children, it’s their weight, not their blood pressure, that predicts whether or not they have LVH—escalating the importance of therapeutic lifestyle change and weight loss in this vulnerable group of obese hypertensive kids.”

Cardiologists have long known that hypertension in children is associated with left ventricular hypertrophy. Now, Johns Hopkins pediatric nephrologist Tammy Brady and other investigators in the Division of Pediatric Cardiology, are finding that obesity is not only a risk factor for hypertension, it’s also an independent predictor of left ventricular hypertrophy.

The good news, says Johns Hopkins pediatric cardiologist Shetarra Walker, is that left ventricular hypertrophy can be reversed with treatment, “and now we know that the best place to start is by treating the obesity, not just the hypertension.”

Johns Hopkins Pediatric Hypertension-Obesity Clinic

But rather than take an advise-parents-and-hope-for-the-best approach, Brady, Walker and a bevy of other Johns Hopkins pediatric specialists have joined forces in a recently created hypertension-obesity clinic that focuses on bringing both health-threatening conditions under control. The clinic’s specialists see patients every three months and create individualized care plans based on an in-depth evaluation of each patient’s particular risks.

Walker says echocardiograms and carotid intimal medial thickness (cIMT) studies show that cardiovascular changes begin early in life, which is why she considers the clinic so important. “We need to start much earlier in teaching children about healthy lifestyles,” she says. In talking with families whose child has left ventricular hypertrophy, her goal is to help them understand how the condition can be reversed if the obesity-caused stress on the heart is removed.

Losing Weight Decreases Risks to the Heart

“Already we have seen amazing changes in some of our patients in terms of weight,” says Brady, who heads the clinic. “We have found that children who lose just 10 percent of their body weight significantly decrease their risk of left ventricular hypertrophy.”

Brady attributes part of their success to the wide-ranging expertise of the clinic’s team, which, in addition to her and Walker, includes a dietitian, physical and occupational therapists, and a behavioral psychologist.

The clinic is still too new to have definitive outcomes data, says Brady, but without such innovative approaches, the prognosis for pediatric patients who are obese and hypertensive will likely continue to be predictably negative.

“Once obese and hypertensive as a child, you are much more likely to be obese and hypertensive as an adult,” Brady says. “And 20 years from now, these are the patients who will have high morbidity and mortality related to heart attacks and strokes. Our hope is that by combining all the expertise at Johns Hopkins into one clinic, our patients will have better outcomes.”

* Effects of obesity and race on left ventricular geometry in hypertensive children. Pruette CS, Fivush BA, Flynn JT, Brady TM: Pediatr Nephrol 2013;28:2015-2022

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