Dr Lim Ing Haan
Heart disease among teenagers is not very common, but also not unheard of. Teens that are not active enough can have an increased risk of metabolic syndrome that could lead to heart problems later in life.
Metabolic syndrome is a series of conditions that occur together, including high blood pressure, increased blood sugar level, excess fat around the waist and abnormal cholesterol levels. The problems associated with metabolic syndrome are largely lifestyle-related and can be reversed if identified early.
Some risk factors can be controlled early in life, thus lowering the risk of heart disease later in life. These risk factors include:
People with obesity are more likely to have high blood pressure, high cholesterol and diabetes, all factors that can increase the risk for heart disease. Central obesity in teenagers with waist circumference above 94cm in male or 80cm in female, places them at higher risk of developing insulin resistance and high fasting glucose.
Recent studies in the US have shown that energy drinks and soft drinks account for 13% of a teenager's calorie intake, leading to obesity – another contributing factor of heart disease.
Many teens have a liking for soft drinks, particularly energy drinks, often relying on the sugar rush as a way of making up for a lack of sleep. Energy drinks are not only high in caffeine, they are also high in sugar, which can provide a temporary energy boost.
Studies have shown that they may cause irregular heartbeats even in healthy people, which can be dangerous to heart health. For teens with an underlying heart condition, they can pose an even greater risk.
Machiatto Lattes and Bubble Teas are also popular among teenagers. These high calorie drinks have little protein and fibre, yet are high in carbohydrates and sugars, leading to raised sugar and insulin resistance, contributing to the global epidemic of metabolic syndrome in teenagers.
A healthy diet, plenty of sleep and exercise are healthier ways to increase energy levels and maintain a healthy heart.
Having high blood pressure means the heart has to pump harder and the arteries are under greater strain. After a while, high blood pressure can damage the heart and other organs.
Research has shown that teenagers who are sleep deprived or have a disturbed sleep are more likely to suffer from both high blood pressure and high cholesterol – both pre-cursors of heart disease.
Late to bed and late to rise, many Singaporean teenagers are not getting enough sleep. While puberty may change the body clock and your teen may think that controlling their own nightly routine is a rite of passage into adulthood, teenagers still need around nine and a half hours of shut eye a night.
Having an elevated low-density lipoprotein (LDL) cholesterol level at a young age raises the risk of developing heart disease. Additionally, a study found that this increased risk persists even in those who were able to later lower their LDL cholesterol level.
This is because the damage that the LDL cholesterol to the arteries seems to be irreversible and cumulative. Therefore, the longer a young person has had high cholesterol, the greater the risk of developing heart disease.
Three main factors contribute to high cholesterol in teens:
Dyslipidaemia occurs in teenagers with metabolic syndrome who have high levels of triglycerides and low levels of high-density lipoprotein (HDL) or good cholesterol. Just like elevated LDL levels, these can also result in increased risk of heart disease.
While many teens start smoking as a way of fitting in with their peers, the nicotine cigarettes contain is addictive.
Nicotine narrows blood vessels and makes the heart work harder. Tar and other chemicals also compound the risk of heart disease.
They can cause build-up of plaque in the arteries, raising cholesterol levels and lowering the efficacy of fibrinogen, an important blood clotting substance.
Among young people, smoking is reported to account for 75% of heart disease cases, which is a sobering thought. By starting smoking at a young age the risk increases – the longer you smoke, the higher the risk of heart disease.
It's a sad fact that 90% of people start smoking before the age of 19. It is estimated that 3 children in every Primary 6 class in Singapore today will eventually be killed by tobacco.
Physical inactivity is a major risk factor for heart disease. A study done among Singapore teens revealed that among those whose blood test results showed increased risk of metabolic syndrome, half of them were of normal weight or even underweight. In these teens, the risk for metabolic syndrome was not caused by any underlying weight issues, but by their sedentary lifestyle.
All teenagers should get at least 60 minutes of exercise every day. This should include a mix of moderate- and high-intensity activities.
If you find that your teen is physically inactive, the first thing you can do is limit the amount of time spent watching TV, playing video games or surfing the internet.
You could also enrol them into organised sports lessons or outdoor clubs that suit their interests. Make physical activities a part of family outings. Biking, walking and hiking are some examples of activities you can do as a family.
Stress isn't a direct risk factor for heart disease in teenagers. However, when people are stressed they often make unhealthy lifestyle choices such as eating unhealthy food, smoking or drinking too much alcohol. Over time these habits can have a negative impact on their heart health.
Stress among teens can be triggered by many things. Common causes of stress include school work, exams, bullying or problems with family or friends. These may manifest in different ways, such as tension, anxiety, emotional exhaustion, sadness, irritability or a sense of being overwhelmed.
Managing stress effectively can make a huge difference to one's physical and mental health. Identifying the cause of stress is key towards managing it. It's also important to talk things through with a trusted person and spending time on other positive activities, including sports and a creative hobby.
In summary, teenagers are at risk of heart disease if they develop metabolic syndrome or any of the risk factors listed above.
Thus the 3 things teenagers can do to keep heart disease at bay is to watch their Diet, Sleep and Exercise. And teenagers should always avoid Smoking! Bring your teen for a health check-up if you suspect he or she is at risk.