But a large body of evidence, much of it collected by the Bogalusa Heart Study, suggests that the causes of heart disease are established in adolescence or even earlier. In 1972, researchers from Tulane University began to collect data on the factors that contribute to heart disease in 14,000 children in Bogalusa, La. They wanted to see if they could track the progression of heart disease from childhood to adulthood. After 32 years of research, Gerald Berenson, lead investigator on the study, states, without hesitation, that "heart disease begins in childhood."
As part of his research, Berenson examined the coronary arteries of 204 young people participating in the study who died unexpectedly after accidents or other trauma. When their arteries were dissected, Berenson discovered "fatty streaks" and "fibrous plaques," which are precursors to heart disease, in the vessels of more than 35 percent of subjects from age 16 to 20. In the 21- to 25-year-old age group, 55 percent of those examined showed early signs of heart disease.
Students from a summer school program watch surgery at Inova Fairfax Hospital's "Dome."
(Photograph by Chris Hartlove)
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Young people who smoked, had high blood pressure, were overweight or had a family history of heart disease exhibited the most damage to their arteries, though most of them hadn't experienced symptoms of heart disease yet, Berenson found. He also saw a direct correlation between the number of risk factors a patient possessed and the severity of the lesions in his or her arteries.
"People don't have any kind of symptoms from it for years," he says. "When they have a heart attack, they've had the disease for a long time before that."
American teenagers are jeopardizing their health in all sorts of ways, according to statistics compiled by the Centers for Disease Control and Prevention and by the American Heart Association. One in three high school students smoke, a habit that more than doubles their risk of having a heart attack. Eighty-five percent of young people eat too much fat on a daily basis, gobbling french fries, burgers, pizza and potato chips every chance they get. Many teens combine a high-fat diet with long hours playing video games, watching television or surfing the Internet. The CDC reports that 22 percent of children from age 9 to 13 get no exercise at all.
The result: an ominous rise in the cholesterol, blood pressure and weight of America's young people. The average cholesterol level in teenagers, 165 mg/dl, is 15 higher than the maximum recommended to keep heart disease at bay. Ten percent of teens already have a total cholesterol level higher than 200 mg/dl, which places them squarely in the "borderline risk" category for developing heart disease, and another 10 percent have high blood pressure that merits treatment. Fifteen percent of teens are obese, which is a major risk factor for developing heart disease.
The explosion in childhood obesity has serious health consequences, doctors warn. Excess body weight increases blood pressure and cholesterol and frequently leads to Type 2 diabetes. A person who is diabetic before age 45 is 14 times more likely to have a heart attack than someone without the disease.
While there's shock value in showing teens what their lifestyle can lead to, LeFrak has modest expectations for the Dome's impact. Not even the sight of a man undergoing bypass surgery is going to change lifelong habits overnight, he says.
"It's one more piece of education," he says, "I don't expect one day to change the whole gestalt of their lives."
Or as Taylor puts it: "The best you can hope for is to plant some seeds. They might not go out and get a gym membership after coming to the Dome, but we can get them thinking and questioning some of what they're doing."
AS THE SURGEON OPENS THE PATIENT'S CHEST, a flabby sac of yellow tissue jiggling at regular intervals becomes visible. "Is that the heart right there?" asks Wendy Reyes, a slim, dark-haired graduating senior from Wakefield High School who works part time at Gold's Gym.
Taylor tells the students that they are looking at the sac surrounding the heart, called the pericardium, a membrane that the surgeon will later cut open to work on the surface of the heart.
Reyes recognizes a lung and notices what looks like a dark spot. Taylor points out that a high percentage of bypass patients are or were smokers and that smoking constricts arteries and makes them more prone to clots. Reyes, who smokes "a few times a week" but who also maintains a regular workout routine, turns in disgust. "God, that's gross," she says.
With the chest open, the surgeon takes the electric scalpel and gets to work detaching the internal mammary artery from the underside of the chest wall, a vessel that will provide one of the grafts for the heart. The other grafts will come from the patient's left leg. To remove this vein, an assistant makes an incision two inches deep that runs from the ankle up to the knee. He clamps and cuts the vein, then begins to tug at the end with a pair of tweezers, as if he's trying to pluck a worm from the ground without breaking it.
