Professor David Celermajer Heart Disease Interview

Professor David Celermajer Heart Disease Interview

Heart disease remains the number one cause of early disability and death in the western world and now, surprisingly, has also become the most frequent cause of early death in the developing world.

Renowned heart researcher Professor David Celermajer presented insights into how to avoid heart disease in adults by detecting the early signs in children at a lecture hosted by the University of Sydney.

The talk forms part of a series of free and public medicine lectures being hosted by the University's Sydney Medical School every Wednesday until 27th of November.

Professor Celermajer said the most important diseases of the heart and blood vessels, such as heart attack, stroke and the effects of rheumatic heart disease, tend to manifest in middle to late age.

'Nevertheless, many of these disease processes take decades to develop and the first changes do start to occur in teenage life," he said.

'Sometimes, the earliest changes can even occur in childhood or rarely, even in foetal life. Recent University of Sydney research found children born to overweight or obese mothers already showed signs of early heart disease, namely thickening of the aortic walls.

'This new appreciation of the very early onset of disease has opened the window to the possibility of early detection and thus improved prevention."

Atherosclerosis is the process of buildup of cholesterol plaques in the main blood vessels of the body that leads to heart attack and stroke.

Professor Celermajer's lab in Sydney was one of the first in the world to describe the earliest changes in the linings of the blood vessels, changes which are the indicators of developing atherosclerosis later in life. These changes can now be detected in humans using non-invasive techniques such as ultrasound, CT and MRI scanning and have given insights into early detection of vascular disease in children and young adults.

'Early detection of heart disease in childhood and young adult life thus opens up the important possibilities of preventing late disease, with enormous potential benefits across the world, to reduce the devastating impact of heart disease in later life," Professor Celermajer said.

Interview with Professor David Celermajer

Question: What are the main points of information you hoped audiences took away from your lecture hosted by the University of Sydney?

Professor David Celermajer:     The first thing is that contrary to what most people think the disease we call Atherosclerosis, which is cholesterol in the blood vessel which causes heart attacks and strokes, this process can actually begin in childhood. It usually causes heart attacks and strokes in people when they're older than 45 years but the process begins when people are children.

 

Our research has revealed four groups of children that we believe are at particularly high risk for Atherosclerosis these groups are:

Kids who are passive smokers, by which I mean, children who grow up in a house were one or two of their parents smoke heavily as that affects their blood vessels in a bad way.

 

Children who have a genetic problem where there cholesterol is very high, which is a condition called pahamilah high cholesterol which means a parent passes a high cholesterol level onto their child, which has nothing to do with diet and the only way we usually find out about it is when the mother or father has a heart attack when they're 35 or 40 years of age and a blood test is done, on the child, who has a high cholesterol as well. There is evidence of blood vessel damage when they're in the first decade of life; it occurs in about 1 in 500 people.

 

The third group is adolescents who are overweight; our research found that adolescents who have a BMI over 22 have abnormal blood vessels that are damaged and that damage can be completely reversed by regular exercise.

 

The fourth group, which will surprise a lot of people, is babies who are born small, not premature babies but those who grow up to term but weigh less than 2.2kg when born. We call it small for gestational age and those children also have abnormal blood vessels.

 

Our research has shown that these four groups have blood vessel damage which puts them at really high risk of early heart attack and stroke.

Question: How can these groups reverse this damage and become low risk?

Professor David Celermajer:    We have done research into how to reverse these problems. It is all well and good to know about it but the idea is if you find it early you might be able to reverse it.  What we've shown in the kids with passive smoking parents, is if they get out of the smoking environment, there blood vessels get back to normal, two years later.

 

Then, if you take kids who have the high cholesterol gene their blood vessels can recover if their high cholesterol is treated with medication.

 

We found, for the kids who are obese, regular exercise, three times a week will reverse that damage even if they stay obese (they can be fat and healthy); but the exercise has to be sustained, they can't exercise for six weeks only, the exercise needs to be kept up.

 

We currently don't know how to reverse the damage for babies who are born small, yet. But we are doing research into ways we think it may be able to be reversed.

Question: What are the most important things for a pregnant woman to do to protect her unborn baby?

Professor David Celermajer:   Make sure she is not around cigarette smoke and absolutely not smoke as this will damage the blood vessels of the unborn baby. If they have a baby who is very small, at birth (less than 2.2kg) those kids, when they get a bit older will need to have their blood pressure checked and they should never be smokers as they're already higher risk.

 

I do not want to alarm people as those babies are not going to drop dead but they are an at risk group for high blood pressure and heart attack later in life. It is better to know at a stage when you can do something about it.

 

As teenagers, if they're overweight, they need to do regular exercise (3 x 45 minute sessions per week) to get their blood pressure health back to normal. Exercise can be fun activites such as aerobics, dance or sport; for kids exercise needs to be fun, or they won't keep it up.

Question: Are there any signs or symptoms for Atherosclerosis?

Professor David Celermajer:    There are no symptoms, until the heart attack happens in later age. The way we saw this was by doing a non-invasive test on the blood vessels called an ultrasound. We invented an ultrasound test that allows us to pick up the early signs of blood vessel damage on the main blood vessels in the arm which will lead to heart attack and stroke, in later life. It is a very difficult test, although not from the patient's point of view. We look at the behaviour of the blood vessels during high flow and look for certain types of damage. We can also do a ultrasound on the main blood vessel in the neck and what we look for there is the thickening of the blood vessels wall.

 

We look for two signs in both ultrasounds one is the thickening of the blood vessels wall and the other are looking at abnormal behaviour of the vessel in the arm, which shows early signs of damage.

 

We don't recommend children have these tests because then we'd be doing it on every child in Australia however we do recommend all children in the high risk groups be very careful with their heart health particularly regular exercise and avoidance of smoking.

Question: Is it possible to remove the thickening of the aortic walls? If so, how?

Professor David Celermajer:     Yes, it can get better. The damage can be reversed and go away with the appropriate intervention. 


Question: How are you hoping to change heart disease rates, in the future?

Professor David Celermajer: Early identification of risk and early appropriate intervention is likely to have a massive impact on the risk of stroke and heart attack in later life.

Interview by Brooke Hunter