The shocking collapse of football safety Damar Hamlin during a recent Monday Night Football game has refocused attention on heart health in younger populations. Our society typically associates increased cardiovascular risk with mature adults. Since February is National Heart Month, now is a good time to review some unexpected cardiovascular risks that can affect young and old alike: type II diabetes, total IgE, and air pollution exposure.
Glucose-insulin regulation (type II diabetes)
Youth-onset type II diabetes (T2D) greatly increases the risk of early cardiovascular disease and increased adverse outcomes. The incidence of T2D is steadily increasing in adolescent populations. Both obesity and low levels of physical activity are considered pre-disposing risk factors. An ongoing large-scale epidemiology study by the Centers for Disease Control (CDC) indicates multiple additional risk factors including:
- Minority racial or ethnic status – particularly in Native American and Native Alaskans, Asian/Pacific Islanders, and Hispanic youth
- Female gender
- Lower population densities of < 500 residents per square mile (towns vs cities)
- Fetal exposure to gestational diabetes or maternal obesity
- Bottle-fed vs breastfed – breastfeeding significantly mitigates the risk of T2D
A dried-urine Organic Acids profile contains multiple biomarkers that, when dysregulated, can raise suspicions about insulin regulation. These disruptions in a patient’s primary biochemical pathways can occur months to years before a conventional hemoglobin A1c test is diagnostic.
Total IgE is a little-known risk factor for cardiovascular disease (CVD). Total IgE is the sum of antigen-specific IgE (foods, pollens, dust, pet dander, etc.) and IgE autoantibodies. The ratio between environmental and auto-IgE antibodies plays a role in determining the risk; if a patient has higher levels of environmental antigen-specific IgE (more allergies), then there is less impact on CVD risk because there are fewer auto-antibodies in the IgE total. Higher IgE levels induce histamine release, and altered local histamine levels can affect liver cholesterol metabolism and ketone production, both of which are related to heart health.
Exposure to fine particulates (< 2.5mm or PM2.5) in air pollution has been associated with cardiac arrhythmias in adolescents, and other chemical exposures have been significantly or suggestively associated with an increased risk of metabolic syndrome (“pre-diabetes”) in Korean adults and adolescent American subjects.
PM2.5 particulates induced premature ventricular contractions (PVCs) within 2 hours of exposure. While rare, frequent PVCs can increase an individual’s risk of sudden cardiac death. Other contributing factors for PVC occurrence include African-American heritage, tobacco, alcohol or caffeine use, anxiety, low mineral levels (low magnesium or potassium), and stimulant medications. It is easy to see how several contributing factors, including air pollution exposures, may combine to create a more significant risk.
Air pollution particulates are, in large part, the result of fossil fuel combustion such as diesel exhaust or black carbon. Particulates may also contain metals, liquids, and vapors that can further increase the potential toxicity of the particle. Smaller particles travel deeper into the lungs, causing inflammation and immune activation.
The Environmental Pollutants profile can be used to screen for exposure to air pollution, fossil fuels, or other products of combustion. Once identified and eliminated from the environment, detoxification may begin. Specific nutrients may be required for certain pollutants; information about nutritional support may be found in both the US BioTek Environmental Pollutants Reference Guide and the Organic Acids Interpretation Guide available online.
Evaluating all patients, young and old, for lesser-known cardiovascular and metabolic risk factors may improve health and decrease risk. Early screening and elimination of toxic exposures combined with personalized nutritional support and lifestyle guidance may reduce overall inflammation and can help each patient reduce their cardiovascular risks and increase their “heart happiness”.
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