New atherosclerosis risk factors in obese, hypertensive and diabetic children and adolescents
Introduction
During the last few years, it has been shown that risk factors for atherosclerosis appear during childhood and adolescence, and are already in that time associated with atherosclerotic changes in vessel walls [1]. This finding, along with the alarming rise in smoking, obesity and hypertension coupled with a decrease of physical activity in children and adolescents, sets a new task for public health, and encourages the development of methods of primary prevention within this age group [2], [3].
Identifying the risk factors for atherosclerosis for individual patients presents an important challenge for modern medicine. The prevention of atherosclerosis is a complex, holistic approach, which involves targeting numerous risk factors simultaneously. Searching for and discovering new risk factors is justified on the grounds that the discovery of traditional risk factors in a patient is not always a good indicator as to their predisposition toward developing atherosclerotic disease. About 25% of patients with coronary artery disease, particularly with premature onset, did not have any of the common, classical risk factors [4]. Numerous studies of proposed new risk factors in children show a correlation with a family history of cardiovascular disease. These studies usually focus on a selected single risk factor, and furthermore, are typically composed of only the healthy young population [5], [6]. Discovering and assessing new risk factors for atherosclerosis in children with recognised traditional risk factors may provide a new insight into the so far not fully understood mechanism of formation of atheromatous plaque, especially during the early first stages, when such changes are entirely reversible [7].
The aim of this work was to determine the concentrations of the routine parameters of lipid profile and metabolism in children and adolescents with obesity, hypertension and diabetes; to determine the concentrations of several new risk factors for atherosclerosis (lipoprotein (a) (Lp(a)), apolipoprotein A-I (Apo A-I), apolipoprotein B (Apo B), homocysteine (Hcy), fibrinogen (FB), tissue plasminogen activator (t-PA) and tissue plasminogen activator inhibitor type 1 (PAI-1)), and to compare the selected groups with the purpose of characterising the type of anomalies in these new risk factors in young patients who carry more classical risk factors for atherosclerosis.
Section snippets
Materials
The study consisted of patients of the IInd Clinic for Children's Diseases of The Medical University of Bialystok, Poland and its related outpatient clinics for Diabetes, Cardiology and Endocrinology. In total, 285 (161 boys, 124 girls) children and adolescents were included, with the mean age being 14.3±3.3 years (age range 6–20). The group was divided according to their diagnosis. Group A (n=49) were obese children. Group B (n=56) were children diagnosed with obesity and coexisting
Patient selection
Obesity was diagnosed when the body mass index (BMI kg/m2), exceeded the 95th centile, matched according to age and sex (using the centile charts for the assessment of somatic development in children and adolescents issued by the Department concerning the physical development of children and adolescents, Institute of Mother and Child) [8]. Children with secondary obesity were not included in the study. High arterial blood pressure was diagnosed using 24-h ambulatory monitoring (ABPM), using the
Laboratory assessment of risk factors
For analysis 10 ml of blood was extracted from the left cubital vein, which was a morning sample taken before breakfast, after a 8–12 h overnight fast, and always taken secondarily when blood was to be taken for regular hospital purposes regarding diagnosis and treatment. To assess Lp(a), Apo B and Apo A-1, blood was taken for clotting, to assess Hcy with EDTA. To assess t-PA and PAI-1, plasma was used with citrate. Plasma and clot were frozen and kept at a temperature of −70 °C until analysis
Results
Serum concentration of cholesterol for all children studied was 166.3±33 mg/dl, and was significantly greater compared with that of the control group: 153.4±23 mg/dl (P<0.01). Significantly higher concentrations of total serum cholesterol were similarly observed for group A (165.5±34 mg/dl, P<0.05), B (168±31 mg/dl, P<0.01), and D (170.6±38 mg/dl, P<0.01). The concentration of LDL in all studied was 97.3±29 mg/dl and was significantly greater compared with that of the control group (89.7±23
Discussion
Evaluating the routine parameters of lipid metabolism showed higher concentrations of cholesterol and LDL in all the groups studied, except for hypertensive children. The highest concentrations of LDL were seen in obese children, and in obese, hypertensive children (group B). HDL levels were significantly lower in obese children groups. Triglyceride concentrations were significantly higher in all the groups studied, when compared with the control. The highest levels in triglyceride
Conclusions
- 1.
Young patients exhibiting obesity, hypertension and diabetes mellitus show significant abnormalities in lipid metabolism, particularly with reference to cholesterol, LDL-cholesterol, triglycerides, and the Lp(a), Apo A-I and Apo B. These abnormalities were most frequently seen in the group of obese children with accompanying hypertension.
- 2.
Elevated concentrations of Hcy appear in hypertensive children and in obese hypertensive children.
- 3.
Elevated concentrations of FB and decreased fibrinolytic
Acknowledgements
This work was supported by the State Committee for Scientific Research Grant No. 4 PO 5E 072 19.
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