The path from chronic inflammation to chronic heart disease

Photo Cred: Charlein Gracia/Unsplash

By Nancy Gahles

Setting out on a path usually infers conscious choice of the direction we are about to take. The path to chronicity, to a situation that becomes sustained over time and leads to pathology is not one that we undertake knowingly.

Wittingly or unwittingly the stresses of life, from early childhood through late adulthood are cumulative. Lifestyle, diet, patterns of behavior are formed early on, within our nuclear home, and carry forward as traditions, rituals, or habits. Often, they are not recognized as harmful until an inharmonious state of body, mind, or spirit arises, which causes disruption enough to warrant attention. These states are called symptoms when isolated or syndromes when grouped together.

The ubiquitous inflammatory states are often the first to manifest themselves. Low-grade fevers, benign, a sign of the innate intelligence of the body mounting a proper defense to an invading organism is a well-known physiological state. This state is first seen in infancy as the immature immune system develops its recognition of invading pathogens and builds its muscles, so to speak. Ear infections or digestive disturbances are considered normal for this time of development. Chronic inflammation presents itself as, indeed, a pattern or path when that child proceeds through each age or grade level with repetitive inflammations, be it earaches, stomachaches, or headaches.

The emotional inflammatory states of frustration, anger, rage, striking, biting, and tantrums are well-known emotional states that are considered benign and transitory in childhood. As we give the child the benefit of the doubt, we consider that the path to cultivating control of their emotions will develop over time. A well hewn path toward self-control is an arduous one and requires emotional intelligence and discipline on the part of the parents and caregivers. As the child approaches grade school and adolescence, a clearer picture of chronicity may present itself with oppositional behavior and learning issues a common syndrome.

The spiritual inflammatory state of despair, with its concomitant decrease in vitality often manifests as depression, weakness, fatigue, and loneliness. This set of symptoms used to be relegated to the elderly. We are now witnessing this path of chronic inflammation in our young adults and throughout adulthood.

We have recently been gifted with the direct experience of Nadine Burke Harris, MD, a pediatrician and current Surgeon General of California, to raise awareness of the pathways to chronic diseases that begin in childhood.

Burke Harris is well-known for linking adverse childhood experiences and toxic stress with harmful effects to health later in life. She founded the Adverse Childhood Experiences project in 2010 and by 2012 the Center for Youth Wellness was created to create a multidisciplinary clinical model that recognizes the impact of adverse events on health and effectively treats toxic stress in children. The approach focuses on preventing and undoing the chemical, physiological, and neurodevelopmental results of adverse childhood experiences (ACEs).

Stress causes inflammation. The why and how of it has likewise been the subject of investigation for years.

The path from chronic inflammation to chronic heart disease is now an illuminated path in healthcare. Recurrent and chronic childhood stress has been known, in some circles, to increase the risk of depression, anxiety, and mood disorders among children and teens, which, in turn leads to unhealthy behaviors that often lead to cardiovascular and metabolic illnesses.

The American Heart Association published a scientific statement and guidelines on December 18, 2017, highlighting the fact that children and teens who experience abuse, bullying, neglect, or witness violence and other forms of adversity are more likely to develop heart and blood vessel diseases as adults. According to the statement, nearly 60 percent of Americans report an adverse event during childhood.

We do know that not all children who grow up facing adversity develop heart disease. We understand that there is a range of resiliency favoring the number of ACEs and the co- existence of other factors such as inherent biological ones, environmental, and sociology-cultural ones.

On June 5, 2018, Burke Harris forged a path by testifying at a briefing before Congress. She called for screening every student for trauma before entering school.  

In my opinion, that is the path from chronic inflammation to the prevention of chronic heart disease. Early detection and early intervention. It is incumbent upon the healthcare providers to come together and devise best practices to achieve and implement this new path.