Modifiable Clinical Correlates of Vascular Health in Children and Adolescents with Dyslipidemia
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Atherosclerosis promoting cardiovascular disease risk factors (CVDrf) are highly prevalent among youth in the U.S. Determining which standard modifiable clinical measures (SMCMs) has the greatest impact on vascular structure and function is valuable for the health care provider to help identify children at highest risk. The aim of this study was to determine modifiable outpatient clinical predictors of vascular health in youth with CVDrf. Children and adolescents with CVDrf (n = 120, 13.1 ± 1.9 years, 49% female) were recruited from a pediatric preventive cardiology clinic. The SMCMs included BMI z-score, waist-to-height ratio (WTHR), lipid panel, hemoglobin A1c, blood pressure (BP), presence of tobacco smoke exposure, and presence of hypertriglyceridemic waist (HTW) phenotype (triglycerides ≥ 110 mg/dL and waist circumference ≥ 90 percentile). Vascular function and structure were measured with pulse wave velocity (PWV), central systolic BP (CSP), augmentation index (AIx), and carotid artery intima-media thickness (cIMT). Sex and height specific z-scores for PWV, CSP, and cIMT were used. Multiple linear regression with backwards selection identified SMCMs which strongly predicted vascular function and structure. Among SMCMs, WTHR and HTW were the most frequent predictors of vascular function (PWV: R2 = 0.32; CSP: R2 = 0.35; AIx R2 = 0.13). Other predictors of vascular function included hemoglobin A1C, BP, and BMI z-score. Systolic BP and LDL cholesterol were predictors of vascular structure (cIMT: R2 = 0.14). The strongest predictors of vascular health in youth with CVDrf were related to measures of central obesity. Targeting these SMCM in lieu of vascular testing in outpatient clinic setting may be practical to identify children and adolescents at greatest risk for CVD.
KeywordsCardiovascular disease Preventive cardiology Modifiable risk factors Children and adolescents Vascular health
Body mass index
Cardiovascular disease risk factors
Carotid artery intima-media thickness
Central systolic pressure
High density lipoprotein cholesterol
Hypertriglyceridemic waist phenotype
Low density lipoprotein cholesterol
Pulse wave velocity
Standard modifiable clinical measures
Kathrine Berry Richardson Foundation internal research award from Children’s Mercy Hospital; and Sarah Morrison medical student research award from the University of Missouri Kansas City, School of Medicine funded this study. We would like to thank our patients who generously shared their time participating in this study.
This study was funded through an internal grant through The Children’s Mercy Hospital supported by the Katherine Berry Richardson Foundation. The study sponsor had no role in study design, data collection, data analysis, interpretation of the results, writing of the manuscript, decision to submit the manuscript, or journal choice.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflicts of interest.
All testing and procedures performed in this study involving human participants were in accordance with the ethical standards of The Children’s Mercy Hospital and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All parents of subjects completed an informed consent and subjects completed assent prior to any research-related procedures involved in this study. DW wrote the first draft and every subsequent draft of the manuscript. No honorarium, grant, or any other form of payment was provided to him for writing the manuscript.
- 1.Sorensen KE, Celemajer DS, Georgakopoulos D, Hatcher G, Betteridge DJ, Deanfield JE (1994) Impairment of endothelium-dependent dilation is an early event in children with familial hypercholesterolemia and is related to lipoprotein(a) level. J Clin Invest 93(1):50–55PubMedPubMedCentralCrossRefGoogle Scholar
- 6.Hall JE (2011) Guton and hall textbook of medical physiology, 12 edn. Saunders Elsevier, PhiladelphiaGoogle Scholar
- 17.Riggio S, Mandraffino G, Sardo M, Iudicello R, Camarda N, Imbalzano E, Alibrandi A, Saitta C, Carerj S, Arrigo T (2010) Pulse wave velocity and augmentation index, but not intima-media thickness, are early indicators of vascular damage in hypercholesterolemic children. Eur J Clin Invest 40(3):250–257PubMedCrossRefGoogle Scholar
- 18.Roman MJ, Devereux RB, Kizer JR, Lee ET, Galloway JM, Ali T, Umans JG, Howard BV (2007) Central pressure more strongly relates to vascular disease and outcome than does brachial pressure: the Strong Heart Study. Hypertension 50(1):197–203. https://doi.org/10.1161/hypertensionaha.107.089078 PubMedCrossRefGoogle Scholar
- 22.Sass C, Herbeth B, Chapet O, Siest G, Visvikis S, Zannad F (1998) Intima–media thickness and diameter of carotid and femoral arteries in children, adolescents and adults from the Stanislas cohort: effect of age, sex, anthropometry and blood pressure. J Hypertens 16(11):1593–1602PubMedCrossRefGoogle Scholar
- 25.Martin SS, Blaha MJ, Elshazly MB, Toth PP, Kwiterovich PO, Blumenthal RS, Jones SR (2013) Comparison of a novel method vs the Friedewald equation for estimating low-density lipoprotein cholesterol levels from the standard lipid profile. JAMA 310(19):2061–2068PubMedPubMedCentralCrossRefGoogle Scholar
- 26.Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, Wei R, Mei Z, Curtin LR, Roche AF, Johnson CL (2000) CDC growth charts: United States. Adv Data (314):1–27Google Scholar
- 33.Butlin M, Qasem A, Battista F, Bozec E, McEniery CM, Millet-Amaury E, Pucci G, Wilkinson IB, Schillaci G, Boutouyrie P, Avolio AP (2013) Carotid-femoral pulse wave valocity assessment using novel cuff-based techniques: comparison with tonometric measurements. J Hypertens 31(11):2237–2243PubMedCrossRefGoogle Scholar
- 39.Milne L, Keehn L, Guilcher A, Reidy JF, Karunanithy N, Rosenthal E, Qureshi S, Chowienczyk PJ, Sinha MD (2015) Central aortic blood pressure from ultrasound wall-tracking of the carotid artery in children: comparison with invasive measurements and radial tonometry. Hypertension 65(5):1141–1146PubMedCrossRefGoogle Scholar
- 41.Butlin M, Qasem A, Avolio AP (2012) Estimation of central aortic pressure waveform features derived from the brachial cuff volume displacement waveform. In: Engineering in Medicine and Biology Society (EMBC), 2012 Annual International Conference of the IEEE, 2591–2594Google Scholar
- 54.Orr JS, Gentile CL, Davy BM, Davy KP (2008) Large artery stiffening with weight gain in humans: role of visceral fat accumulation. Hypertension 51(6):1519–1524. https://doi.org/10.1161/hypertensionaha.108.112946 PubMedPubMedCentralCrossRefGoogle Scholar
- 56.Diamant M, Lamb HJ, van de Ree MA, Endert EL, Groeneveld Y, Bots ML, Kostense PJ, Radder JK (2005) The association between abdominal visceral fat and carotid stiffness is mediated by circulating inflammatory markers in uncomplicated type 2 diabetes. J Clin Endocrinol Metab 90(3):1495–1501. https://doi.org/10.1210/jc.2004-1579 PubMedCrossRefGoogle Scholar
- 60.Lemieux I, Pascot A, Couillard C, Lamarche B, Tchernof A, Alméras N, Bergeron J, Gaudet D, Tremblay G, Prud’homme D (2000) Hypertriglyceridemic waist: a marker of the atherogenic metabolic triad (hyperinsulinemia; hyperapolipoprotein B; small, dense LDL) in men? Circulation 102(2):179–184PubMedCrossRefGoogle Scholar
- 63.McCarthy HD, Ashwell M (2006) A study of central fatness using waist-to-height ratios in UK children and adolescents over two decades supports the simple message–’keep your waist circumference to less than half your height’. Int J Obes 30(6):988–992. https://doi.org/10.1038/sj.ijo.0803226 CrossRefGoogle Scholar
- 66.Glagov S, Vito R, Giddens DP, Zarins CK (1992) Micro-architecture and composition of artery walls: relationship to location, diameter and. J Hypertens 10(6):S101–S104Google Scholar