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Excerpt
Within the pediatric health care community there is general consensus that prevention of cardiovascular disease (CVD), a major cause of death and disability in the United States, should begin in childhood. Some controversy exists, however, regarding the efficacy and timing of preventive interventions. This report, part of a longitudinal twin-family study conducted by the authors, was designed to examine the genetic and environmental influences on risk factors for CVD during adolescence. The use of twins was planned because the researchers sought to analyze the similarity or difference in risk factors between monozygotic twins (who share the same genes) and dizygotic twins (who are no more alike than siblings).
This study used 56 identical and 29 (same sex) fraternal twin pairs, with a mean age of 12.6 years; approximately half of the sample was female. All 75 twin pairs had participated in phase I of the study when they were school-age (mean age was 8.5 years), so data were available to compare these children at age 8 and then again at age 12. Nurses collected fasting blood specimens for lipid profiles, systolic-diastolic blood pressure, and body mass index in the twins' home environment. In addition, teachers rated the twins' type A behaviors using the Matthews Youth Test for Health in order to assist the researchers with understanding, in a standardized fashion, the possible role of behavioral and personality components of CVD risk factors, including impatience-aggression and competetive achievement striving.
The results were intriguing. When comparing data from these children at 8 years of age to the data when they reached the age of 12 years, the study found that changes had occurred. At age 12, the genetic influence seemed to be stronger for the physiologic measures (total cholesterol, HDL cholesterol, triglycerides, body mass index, and blood pressure) than for the behavior measures, stronger than it had been at age 8 for these subjects.
What do these results mean for nursing practice? Collectively the results suggest that the potential to modify risk profiles during the transition from childhood to adolescence is great, and that we as nurses should start health teaching about the importance of primary prevention early in a child's life instead of waiting until adolescence or older. One of the major focal points for cardiovascular health promotion and risk reduction is the prevention and control of obesity during the transition from childhood to adulthood. Interventions focused on adopting and maintaining the "heart-healthy" diet (also known as the American Heart Association's step 1 diet) and physical fitness are recommended to prevent obesity and risk for CVD. Across health care settings, nurses could be instrumental in implementing these preventive interventions during childhood to help prevent the decline in physical fitness that occurs during adolescence. Nurses must continue to conduct research toward understanding the best ways to help children and adolescents establish and maintain healthful lifestyles.
