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Childhood Obesity, Atherogenesis, and Adult Cardiovascular Disease

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Pediatric Obesity

Part of the book series: Contemporary Endocrinology ((COE))

Abstract

Pediatric obesity predisposes to hypertension, dyslipidemia, and diabetes and is a major risk factor for adult cardiovascular disease. In this chapter, we present evidence that atherosclerosis begins in childhood, increases with age, and is accelerated by multiple risk factors. Additionally, we discuss the application of noninvasive imaging modalities to assess early atherosclerosis and summarize the studies demonstrating the utility of these methods in pediatric obesity. We conclude with strategies for prevention, which is essential to limiting adult cardiovascular disease.

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References

  1. McGill HC Jr. The pathogenesis of atherosclerosis. Clin Chem. 1988;34:B33–9.

    PubMed  Google Scholar 

  2. Holman RL, Mc GH Jr, Strong JP, Geer JC. Observations on the natural history of atherosclerosis. J La State Med Soc. 1958;110:361–9.

    CAS  PubMed  Google Scholar 

  3. Berenson GS, Srinivasan SR, Bao W, et al. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med. 1998;338:1650–6.

    Article  CAS  PubMed  Google Scholar 

  4. McGill HC Jr, McMahan CA. Determinants of atherosclerosis in the young. Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. Am J Cardiol. 1998;82:30T–6T.

    Article  PubMed  Google Scholar 

  5. HC MG Jr, McMahan CA, Zieske AW, et al. Associations of coronary heart disease risk factors with the intermediate lesion of atherosclerosis in youth. The Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. Arterioscler Thromb Vasc Biol. 2000;20:1998–2004.

    Article  Google Scholar 

  6. Cornhill JF, Herderick EE, Vince DG. The clinical morphology of human atherosclerotic lesions. Lessons from the PDAY Study. Pathobiological Determinants of Atherosclerosis in Youth. Wien Klin Wochenschr. 1995;107:540–3.

    CAS  PubMed  Google Scholar 

  7. Homma S, Ishii T, Malcom GT, et al. Histopathological modifications of early atherosclerotic lesions by risk factors—findings in PDAY subjects. Atherosclerosis. 2001;156:389–99.

    Article  CAS  PubMed  Google Scholar 

  8. McMahan CA, Gidding SS, Malcom GT, et al. Comparison of coronary heart disease risk factors in autopsied young adults from the PDAY Study with living young adults from the CARDIA study. Cardiovasc Pathol. 2007;16:151–8.

    Article  PubMed  Google Scholar 

  9. McMahan CA, McGill HC, Gidding SS, et al. PDAY risk score predicts advanced coronary artery atherosclerosis in middle-aged persons as well as youth. Atherosclerosis. 2007;190:370–7.

    Article  CAS  PubMed  Google Scholar 

  10. McGill HC Jr, McMahan CA, Herderick EE, et al. Effects of coronary heart disease risk factors on atherosclerosis of selected regions of the aorta and right coronary artery. PDAY Research Group. Pathobiological Determinants of Atherosclerosis in Youth. Arterioscler Thromb Vasc Biol. 2000;20:836–45.

    Article  PubMed  Google Scholar 

  11. McGill HC Jr, McMahan CA, Herderick EE, et al. Obesity accelerates the progression of coronary atherosclerosis in young men. Circulation. 2002;105:2712–8.

    Article  PubMed  Google Scholar 

  12. Berenson GS, Wattigney WA, Tracy RE, et al. Atherosclerosis of the aorta and coronary arteries and cardiovascular risk factors in persons aged 6 to 30 years and studied at necropsy (The Bogalusa Heart Study). Am J Cardiol. 1992;70:851–8.

    Article  CAS  PubMed  Google Scholar 

  13. Tracy RE, Newman WP 3rd, Wattigney WA, Berenson GS. Risk factors and atherosclerosis in youth autopsy findings of the Bogalusa Heart Study. Am J Med Sci. 1995;310(Suppl 1):S37–41.

    Article  PubMed  Google Scholar 

  14. Tracy RE, Newman WP 3rd, Wattigney WA, et al. Histologic features of atherosclerosis and hypertension from autopsies of young individuals in a defined geographic population: the Bogalusa Heart Study. Atherosclerosis. 1995;116:163–79.

    Article  CAS  PubMed  Google Scholar 

  15. Heald FP. The natural history of obesity. Adv Psychosom Med. 1972;7:102–15.

    Article  CAS  PubMed  Google Scholar 

  16. Mann GV. The influence of obesity on health (first of two parts). N Engl J Med. 1974;291:178–85.

    Article  CAS  PubMed  Google Scholar 

  17. Mann GV. The influence of obesity on health (second of two parts). N Engl J Med. 1974;291:226–32.

    Article  CAS  PubMed  Google Scholar 

  18. Rabkin SW, Mathewson FA, Hsu PH. Relation of body weight to development of ischemic heart disease in a cohort of young North American men after a 26 year observation period: the Manitoba Study. Am J Cardiol. 1977;39:452–8.

    Article  CAS  PubMed  Google Scholar 

  19. Hubert HB, Feinleib M, McNamara PM, Castelli WP. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation. 1983;67:968–77.

    Article  CAS  PubMed  Google Scholar 

  20. Lee IM, Manson JE, Hennekens CH, Paffenbarger RS Jr. Body weight and mortality. A 27-year follow-up of middle-aged men. JAMA. 1993;270:2823–8.

    Article  CAS  PubMed  Google Scholar 

  21. Alexander JK. Obesity and coronary heart disease. Am J Med Sci. 2001;321:215–24.

    Article  CAS  PubMed  Google Scholar 

  22. Freedman DS, Khan LK, Serdula MK, et al. The relation of childhood BMI to adult adiposity: the Bogalusa Heart Study. Pediatrics. 2005;115:22–7.

    Article  PubMed  Google Scholar 

  23. Mahoney LT, Lauer RM, Lee J, Clarke WR. Factors affecting tracking of coronary heart disease risk factors in children. The Muscatine Study. Ann N Y Acad Sci. 1991;623:120–32.

    Article  CAS  PubMed  Google Scholar 

  24. Juhola J, Magnussen CG, Viikari JS, et al. Tracking of serum lipid levels, blood pressure, and body mass index from childhood to adulthood: the Cardiovascular Risk in Young Finns Study. J Pediatr. 2011;159:584–90.

    Article  CAS  PubMed  Google Scholar 

  25. Baker JL, Olsen LW, Sorensen TI. Childhood body-mass index and the risk of coronary heart disease in adulthood. N Engl J Med. 2007;357:2329–37.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Bogers RP, Bemelmans WJ, Hoogenveen RT, et al. Association of overweight with increased risk of coronary heart disease partly independent of blood pressure and cholesterol levels: a meta-analysis of 21 cohort studies including more than 300 000 persons. Arch Intern Med. 2007;167:1720–8.

    Article  PubMed  Google Scholar 

  27. Dawber TR, Moore FE, Mann GV. Coronary heart disease in the Framingham study. Am J Public Health Nations Health. 1957;47:4–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. May AL, Kuklina EV, Yoon PW. Prevalence of cardiovascular disease risk factors among US adolescents, 1999–2008. Pediatrics. 2012;129:1035–41.

    Article  PubMed  Google Scholar 

  29. Skinner AC, Perrin EM, Moss LA, Skelton JA. Cardiometabolic risks and severity of obesity in children and young adults. N Engl J Med. 2015;373:1307–17.

    Article  PubMed  Google Scholar 

  30. McMahan CA, Gidding SS, Malcom GT, et al. Pathobiological determinants of atherosclerosis in youth risk scores are associated with early and advanced atherosclerosis. Pediatrics. 2006;118:1447–55.

    Article  PubMed  Google Scholar 

  31. Gidding SS, McMahan CA, McGill HC, et al. Prediction of coronary artery calcium in young adults using the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) risk score: the CARDIA study. Arch Intern Med. 2006;166:2341–7.

    Article  CAS  PubMed  Google Scholar 

  32. Kelly AS, Barlow SE, Rao G, et al. Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association. Circulation. 2013;128:1689–712.

    Article  PubMed  Google Scholar 

  33. Claire Wang Y, Gortmaker SL, Taveras EM. Trends and racial/ethnic disparities in severe obesity among US children and adolescents, 1976–2006. Int J Pediatr Obes. 2011;6:12–20.

    Article  CAS  PubMed  Google Scholar 

  34. Shah AS, Dolan LM, Khoury PR, et al. Severe obesity in adolescents and young adults is associated with subclinical cardiac and vascular changes. J Clin Endocrinol Metab. 2015;100:2751–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Urbina EM, Williams RV, Alpert BS, et al. Noninvasive assessment of subclinical atherosclerosis in children and adolescents: recommendations for standard assessment for clinical research: a scientific statement from the American Heart Association. Hypertension. 2009;54:919–50.

    Article  CAS  PubMed  Google Scholar 

  36. Groner JA, Joshi M, Bauer JA. Pediatric precursors of adult cardiovascular disease: noninvasive assessment of early vascular changes in children and adolescents. Pediatrics. 2006;118:1683–91.

    Article  PubMed  Google Scholar 

  37. Chambless LE, Heiss G, Folsom AR, et al. Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987–1993. Am J Epidemiol. 1997;146:483–94.

    Article  CAS  PubMed  Google Scholar 

  38. O’Leary DH, Polak JF, Kronmal RA, et al. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med. 1999;340:14–22.

    Article  PubMed  Google Scholar 

  39. Simons PC, Algra A, Bots ML, Grobbee DE, van der Graaf Y. Common carotid intima-media thickness and arterial stiffness: indicators of cardiovascular risk in high-risk patients. The SMART Study (Second Manifestations of ARTerial disease). Circulation. 1999;100:951–7.

    Article  CAS  PubMed  Google Scholar 

  40. Meyer AA, Kundt G, Steiner M, Schuff-Werner P, Kienast W. Impaired flow-mediated vasodilation, carotid artery intima-media thickening, and elevated endothelial plasma markers in obese children: the impact of cardiovascular risk factors. Pediatrics. 2006;117:1560–7.

    Article  PubMed  Google Scholar 

  41. Woo KS, Chook P, Yu CW, et al. Overweight in children is associated with arterial endothelial dysfunction and intima-media thickening. Int J Obes Relat Metab Disord. 2004;28:852–7.

    Article  CAS  PubMed  Google Scholar 

  42. Juonala M, Viikari JS, Kahonen M, et al. Life-time risk factors and progression of carotid atherosclerosis in young adults: the Cardiovascular Risk in Young Finns study. Eur Heart J. 2010;31:1745–51.

    Article  CAS  PubMed  Google Scholar 

  43. Li S, Chen W, Srinivasan SR, et al. Childhood cardiovascular risk factors and carotid vascular changes in adulthood: the Bogalusa Heart Study. JAMA. 2003;290:2271–6.

    Article  CAS  PubMed  Google Scholar 

  44. Davis PH, Dawson JD, Riley WA, Lauer RM. Carotid intimal-medial thickness is related to cardiovascular risk factors measured from childhood through middle age: The Muscatine Study. Circulation. 2001;104:2815–9.

    Article  CAS  PubMed  Google Scholar 

  45. Freedman DS, Dietz WH, Tang R, et al. The relation of obesity throughout life to carotid intima-media thickness in adulthood: the Bogalusa Heart Study. Int J Obes Relat Metab Disord. 2004;28:159–66.

    Article  CAS  PubMed  Google Scholar 

  46. Oren A, Vos LE, Uiterwaal CS, et al. Change in body mass index from adolescence to young adulthood and increased carotid intima-media thickness at 28 years of age: the Atherosclerosis Risk in Young Adults study. Int J Obes Relat Metab Disord. 2003;27:1383–90.

    Article  CAS  PubMed  Google Scholar 

  47. Silva LR, Stefanello JM, Pizzi J, Timossi LS, Leite N. Atherosclerosis subclinical and inflammatory markers in obese and nonobese children and adolescents. Rev Bras Epidemiol. 2012;15:804–16.

    Article  PubMed  Google Scholar 

  48. Nunez F, Martinez-Costa C, Sanchez-Zahonero J, et al. Carotid artery stiffness as an early marker of vascular lesions in children and adolescents with cardiovascular risk factors. Rev Esp Cardiol. 2010;63:1253–60.

    Article  PubMed  Google Scholar 

  49. Pierce GL, Zhu H, Darracott K, et al. Arterial stiffness and pulse-pressure amplification in overweight/obese African-American adolescents: relation with higher systolic and pulse pressure. Am J Hypertens. 2013;26:20–6.

    Google Scholar 

  50. Dawson JD, Sonka M, Blecha MB, Lin W, Davis PH. Risk factors associated with aortic and carotid intima-media thickness in adolescents and young adults: the Muscatine Offspring Study. J Am Coll Cardiol. 2009;53:2273–9.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Townsend RR, Wilkinson IB, Schiffrin EL, et al. Recommendations for improving and standardizing vascular research on arterial stiffness: a scientific statement from the American Heart Association. Hypertension. 2015;66:698–722.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Urbina EM, Brinton TJ, Elkasabany A, Berenson GS. Brachial artery distensibility and relation to cardiovascular risk factors in healthy young adults (The Bogalusa Heart Study). Am J Cardiol. 2002;89:946–51.

    Article  PubMed  Google Scholar 

  53. Laurent S, Cockcroft J, Van Bortel L, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006;27:2588–605.

    Article  PubMed  Google Scholar 

  54. McLeod AL, Uren NG, Wilkinson IB, et al. Non-invasive measures of pulse wave velocity correlate with coronary arterial plaque load in humans. J Hypertens. 2004;22:363–8.

    Article  CAS  PubMed  Google Scholar 

  55. Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol. 2010;55:1318–27.

    Article  PubMed  Google Scholar 

  56. van Sloten TT, Schram MT, van den Hurk K, et al. Local stiffness of the carotid and femoral artery is associated with incident cardiovascular events and all-cause mortality: the Hoorn study. J Am Coll Cardiol. 2014;63:1739–47.

    Article  PubMed  Google Scholar 

  57. Brinton TJ, Cotter B, Kailasam MT, et al. Development and validation of a noninvasive method to determine arterial pressure and vascular compliance. Am J Cardiol. 1997;80:323–30.

    Article  CAS  PubMed  Google Scholar 

  58. Zebekakis PE, Nawrot T, Thijs L, et al. Obesity is associated with increased arterial stiffness from adolescence until old age. J Hypertens. 2005;23:1839–46.

    Article  CAS  PubMed  Google Scholar 

  59. Tounian P, Aggoun Y, Dubern B, et al. Presence of increased stiffness of the common carotid artery and endothelial dysfunction in severely obese children: a prospective study. Lancet. 2001;358:1400–4.

    Article  CAS  PubMed  Google Scholar 

  60. Urbina EM, Kimball TR, Khoury PR, Daniels SR, Dolan LM. Increased arterial stiffness is found in adolescents with obesity or obesity-related type 2 diabetes mellitus. J Hypertens. 2010;28:1692–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Hudson LD, Rapala A, Khan T, Williams B, Viner RM. Evidence for contemporary arterial stiffening in obese children and adolescents using pulse wave velocity: a systematic review and meta-analysis. Atherosclerosis. 2015;241:376–86.

    Article  CAS  PubMed  Google Scholar 

  62. Furchgott RF, Zawadzki JV. The obligatory role of endothelial cells in the relaxation of arterial smooth muscle by acetylcholine. Nature. 1980;288:373–6.

    Article  CAS  PubMed  Google Scholar 

  63. Palmer RM, Ferrige AG, Moncada S. Nitric oxide release accounts for the biological activity of endothelium-derived relaxing factor. Nature. 1987;327:524–6.

    Article  CAS  PubMed  Google Scholar 

  64. Deanfield J, Donald A, Ferri C, et al. Endothelial function and dysfunction. Part I: Methodological issues for assessment in the different vascular beds: a statement by the Working Group on Endothelin and Endothelial Factors of the European Society of Hypertension. J Hypertens. 2005;23:7–17.

    Article  CAS  PubMed  Google Scholar 

  65. Cox DA, Vita JA, Treasure CB, et al. Atherosclerosis impairs flow-mediated dilation of coronary arteries in humans. Circulation. 1989;80:458–65.

    Article  CAS  PubMed  Google Scholar 

  66. Ryder JR, Dengel DR, Jacobs DR Jr, et al. Relations among adiposity and insulin resistance with flow-mediated dilation, carotid intima-media thickness, and arterial stiffness in children. J Pediatr. 2016;168:205–11.

    Article  PubMed  Google Scholar 

  67. Woo KS, Chook P, Yu CW, et al. Effects of diet and exercise on obesity-related vascular dysfunction in children. Circulation. 2004;109:1981–6.

    Article  PubMed  Google Scholar 

  68. Hopkins ND, Stratton G, Tinken TM, et al. Relationships between measures of fitness, physical activity, body composition and vascular function in children. Atherosclerosis. 2009;204:244–9.

    Article  CAS  PubMed  Google Scholar 

  69. Meyer AA, Kundt G, Lenschow U, Schuff-Werner P, Kienast W. Improvement of early vascular changes and cardiovascular risk factors in obese children after a six-month exercise program. J Am Coll Cardiol. 2006;48:1865–70.

    Article  PubMed  Google Scholar 

  70. Feletou M, Vanhoutte PM. Endothelial dysfunction: a multifaceted disorder (The Wiggers Award Lecture). Am J Physiol Heart Circ Physiol. 2006;291:H985–H1002.

    Article  CAS  PubMed  Google Scholar 

  71. Chen W, Srinivasan SR, Li S, Xu J, Berenson GS. Metabolic syndrome variables at low levels in childhood are beneficially associated with adulthood cardiovascular risk: the Bogalusa Heart Study. Diabetes Care. 2005;28:126–31.

    Article  PubMed  Google Scholar 

  72. Laitinen TT, Pahkala K, Magnussen CG, et al. Ideal cardiovascular health in childhood and cardiometabolic outcomes in adulthood: the Cardiovascular Risk in Young Finns Study. Circulation. 2012;125:1971–8.

    Article  PubMed  Google Scholar 

  73. Aatola H, Koivistoinen T, Hutri-Kahonen N, et al. Lifetime fruit and vegetable consumption and arterial pulse wave velocity in adulthood: the Cardiovascular Risk in Young Finns Study. Circulation. 2010;122:2521–8.

    Article  PubMed  Google Scholar 

  74. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics 2011;128(Suppl 5):S213–56.

    Google Scholar 

  75. Twig G, Yaniv G, Levine H, et al. Body-mass index in 2.3 million adolescents and cardiovascular death in adulthood. N Engl J Med. 2016;374:2430–40.

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank Drs. Henry C. McGill Jr, Alex McMahan and Samuel S. Gidding for writing the first version of this chapter. While much of the original content was preserved, several additions were made to reflect current knowledge of the effects of pediatric obesity on cardiovascular disease.

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Correspondence to Amy S. Shah MD, MS .

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Shah, A.S., Urbina, E.M. (2018). Childhood Obesity, Atherogenesis, and Adult Cardiovascular Disease. In: Freemark, M. (eds) Pediatric Obesity. Contemporary Endocrinology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-68192-4_30

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  • DOI: https://doi.org/10.1007/978-3-319-68192-4_30

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