What Age is Too Early to See a Cardiologist?

This spring, the Comprehensive Hypertension Center at the University of Miami will begin seeing patients as young as 13 for cardiovascular health evaluations. The goal is to prevent cardiovascular disease in patients with an increased hereditary risk of heart disease.

Maria Delgado-Lelievre, M.D., was stunned by the cholesterol test results from her patient’s young daughter. The girl’s father had a heart attack in his 30s –– a sure sign of a hereditary predisposition for heart disease that can be passed from parents to children. The man requested blood tests for his kids to determine their risk.

One child’s results were nearly identical to the father’s.” When I saw the results, I said it must have been a mistake. Perhaps somebody ran the father’s blood sample as if it was the daughter’s,” she says.

Dr. Delgado, a hypertension and cardiovascular prevention specialist, requested another blood test for the child only to find the same results.

Signs of cardiovascular disease risk in younger patients

Pediatric cardiologists typically work with children who have congenital heart problems from issues they have since birth. Cardiovascular disease that can lead to a heart attack or stroke is usually diagnosed in adults over 50 who show signs of disease progression.

However, Dr. Delgado regularly sees young adults in their teens and 20s already showing signs of heart disease.

Hypertension –– the medical condition of high blood pressure — is the most common cardiovascular disease in the world. High blood pressure can cause plaque to build up in your arteries and veins, which eventually leads to blockages that result in a heart attack or stroke.

Close to 50% of the United States population will eventually become hypertensive. “Despite those numbers, many patients experience a sudden heart attack or stroke without ever realizing they’ve been hypertensive for years,” says Dr. Delgado.

As founding director of the Comprehensive Hypertension Center at the University of Miami, Dr. Delgado seeks to change that for South Florida residents.

Why young patients at risk for cardiovascular disease are often overlooked.

Typically, when teens have a high blood pressure measurement, their provider assumes this is caused by feeling nervous at the doctor. This is common among children and adults and even is called “white coat hypertension.”

In some cases, though, assuming a high blood pressure reading in young people isn’t accurate can mask other underlying causes. “Instead of asking if there’s any family history of hypertension, most providers will tell a parent not to worry because the kid is just anxious,” says Dr. Delgado.

Providers need to ask these patients if any grandparent has high blood pressure, says Dr. Delgado. “Parents of teens are often still in their 40s and may not have developed hypertension yet, but if it runs in the family, they probably will eventually, and the kids are at risk.”

While teens and young adults with an inherited risk of heart disease typically aren’t yet hypertensive, they can show signs of vascular abnormalities that a cardiologist can detect.

Genetics and heart disease

Genetics is a contributing cause for most people with heart disease. This is nearly always the case when someone shows signs of heart disease under age 50. For example, with hypertension, all you need is for one grandparent to be hypertensive for the next generations to develop it.

Obesity exacerbates any familial risk of heart disease by causing inflammation in the body, even among young people. “Lifestyle factors such as a healthy diet and regular exercise can lower your risk, but that risk still exists if hypertension runs in your family,” says Dr. Delgado.

Getting evaluated for cardiovascular disease risk

A typical screening for a patient with a family history of heart disease includes:

• a physical exam
• blood and urine tests
• a 24-hour blood pressure monitor

Dr. Delgado recommends a disposable patch blood pressure monitor that can be placed on the chest and connected to a phone by Bluetooth.

“This makes a major difference because there’s no bias from thinking about your blood pressure being measured –– especially for kids who might be embarrassed to wear this sort of device in school,” says Dr. Delado.

If any screening results show early signs of hypertension, the next step is to get a heart scan. One type is a coronary calcium scan that looks at how much calcium has built up in the coronary arteries or an echocardiogram (EKG) that shows the heart in real time.

Preventing heart disease progression in younger patients

Getting screened for an increased risk of heart disease doesn’t mean putting more kids on medication, says Dr. Delgado. Besides keeping up with wellness checkups, the initial intervention for preventing heart disease progression in kids includes healthy diet changes, regular exercise and effective stress relief.

“The beauty of preventive cardiology for young people is that it’s not typically pharmacological. We just need to start educating these kids and their parents,” says Dr. Delgado.

If Dr. Delgado has her way, a significant percentage of cardiovascular disease among residents of South Florida would be prevented. Seeing patients as early as 13 and spreading awareness of how even teens can take steps to lower their risk of heart disease is a significant step toward reaching her goal.

“We’re going to create a culture where a teen who is borderline or at risk will receive important health education about getting annual blood pressure checks and limiting sodium and processed foods in their diets,” says Dr. Delgado.

Eventually, Dr. Delgado hopes the hypertension center’s initiative to see patients as young as 13 in Miami will become a model for other hypertension centers nationwide. “There’s a great opportunity in education to prevent early cardiovascular onset. If we do this across the population, we’ll save many lives.”

Call the Comprehensive Hypertension Center at (305) 243-5554 to make an appointment or request an in-person or virtual visit online.

The Comprehensive Hypertension Center at the University of Miami is the only American Heart Association-certified center in South Florida. The center has received the American Heart Association/American Medical Association Target: BP Gold Plus Award for the second consecutive year for excellence in blood pressure control.

Wendy Margolin is a contributor for UHealth’s news service.

Tags: Dr. Maria Delgado