ORLANDO – Fully two-thirds of nearly 25,000 Dallas-area volunteer blood donors ages 16-19 had elevated or borderline total cholesterol, blood pressure, and/or hemoglobin A1c, Dr. Merlyn H. Sayers reported at the American Heart Association scientific sessions.
“It is startling that such a significant percentage of these young, ostensibly healthy volunteers have abnormal cardiometabolic health metrics,” observed Dr. Sayers, president and chief executive officer of Carter BloodCare of Bedford, Tex., a nonprofit organization that is the largest blood bank in the state.
After all, he noted, longitudinal studies have clearly shown that cardiometabolic risk factors present in adolescence will persist into adulthood and are associated with increased risks of cardiovascular disease and diabetes. Moreover, it’s troubling, albeit not really surprising, that for the most part these adolescents don’t seem to care about their cardiometabolic risk, the hematologist-oncologist added.
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Dr. Merlyn H. Sayers
“We give all these youngsters an opportunity to go to the Carter BloodCare website and confidentially retrieve their values. But despite all manner of urging on our part that these results are important, at best only about 20% of the individuals actually do so, and that rate varies substantially by race and ethnicity,” according to Dr. Sayers. “Where appropriate, we need to find ways to impose behavior modification on a group that is relatively resistant to guidance and intervention. Even the best kids, as teenagers, really don’t take this sort of advice about their health risk very seriously. They regard themselves as immortal during their teenage years.”
Noting that behavioral change is not a core strength among transfusion medicine specialists, Dr. Sayers appealed to his audience of cardiologists for suggestions as to how to encourage lifestyle modification in this youthful group without browbeating them to the point that they’re driven off from becoming serial blood donors.
It’s not widely appreciated that across the U.S. during the school year, 20% of all unpaid blood donors are high school students. These high school blood drives provide an as-yet untapped opportunity to screen adolescents for cardiometabolic risk at low cost and minimal inconvenience to participants, said Dr. Sayers of the University of Texas, Dallas.
“We need allies to help us to ensure we get the kids’ attention better,” he explained. “I want to leave you with the sense that perhaps you will see these blood drives as an opportunity to find interventions that might address primordial prevention of cardiometabolic risk.”
He presented a study of 24,925 youths aged 16-19 who donated blood to Carter BloodCare during 2011-2012. Since blood is drawn for obligatory infectious diseases screening at each donation, Dr. Sayers and coinvestigators were able to measure nonfasting total cholesterol and HbA1c in every teen donor. Blood pressure is also measured at every donation.
The investigators used widely accepted definitions of elevated blood pressure, cholesterol, and HbA1c: namely, at least 140/80 mm Hg, 200 mg/dL, and 6.5%, respectively.
While the percentage of teen blood donors with borderline or elevated levels of all three cardiometabolic risk factors was in the low single figures, 21% of boys and 15% of girls were positive for two out of the three.
The prevalence of cardiometabolic risk factors varied by ethnicity. Sixteen percent of white adolescents had elevated or borderline levels of two risk factors. So did 24% of African Americans, 22% of Asian Americans, and 18% of Hispanics.
“These are really staggering results,” commented session chair Dr. Seth S. Martin of Johns Hopkins University, Baltimore. “This is a call to action now that you’ve identified all these kids who are on a trajectory that doesn’t look good.”
As to how physicians can help to favorably alter that trajectory, however, audience members admitted to being stumped, especially since many young people stop going to a primary care physician for preventive care during their teenage years.
“The big problem here is how to use this information to initiate lifestyle change,” observed Dr. Lewis H. Kuller, professor and past chair of epidemiology at the University of Pittsburgh.
Dr. Sayers reported having no financial conflicts regarding his study.