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Vérier CMP, Duhamel A, Béghin L, Diaz LE, Warnberg J, Marcos A, Gómez-Martínez S, Manios Y, De Henauw S, Sjöström M, Moreno LA, Kersting M, Breidenassel C, Molnar D, Artero EG, Ferrari M, Widhalm K, Turck D, Gottrand F. Breastfeeding in infancy is not associated with inflammatory status in healthy adolescents. J Nutr 2011; 141:411-7. [PMID: 21248197 DOI: 10.3945/jn.110.128249] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
It has been suggested that breast-feeding (BF) may be associated with a decreased risk of cardiovascular disease in adulthood. A low-grade inflammation is associated with an increased risk of cardiovascular disease, even in apparently healthy children. The objective of this study was to assess the potential modulating effect of BF on the inflammatory status of healthy adolescents. Information on BF (duration) was obtained from parental records in 484 of 1040 healthy European urban adolescents (56.4% females) that had a blood sample obtained as part of the Healthy Lifestyle in Europe by Nutrition and Adolescence study. Blood serum inflammatory markers were measured, including high sensitivity C-reactive protein, complement factors 3 and 4, ceruloplasmin, adhesion molecules (L-selectin and soluble endothelial selectin, soluble vascular cell adhesion molecule 1, and intercellular adhesion molecule 1), cytokines, TGFβ1, and white blood cells. After univariate analysis, a propensity score, including the potential confounding factors, was computed and used to assess the association between BF and selected inflammatory markers. BF was not significantly associated with any of the selected inflammatory markers after adjustment for gender and propensity score. In our study, BF was not associated with low-grade inflammatory status in healthy adolescents, suggesting that the potential cardiovascular benefits of BF are related to other mechanisms than modulation of inflammation or might become relevant at a later age. Groups at high risk for cardiovascular disease should be a target for further research concerning the effects of BF.
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Affiliation(s)
- Caroline M P Vérier
- Inserm U995, IFR114, Department of Paediatrics, Faculty of Medicine, University of Lille 2, Lille 59037, France
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102
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Danese A, Caspi A, Williams B, Ambler A, Sugden K, Mika J, Werts H, Freeman J, Pariante CM, Moffitt TE, Arseneault L. Biological embedding of stress through inflammation processes in childhood. Mol Psychiatry 2011; 16:244-6. [PMID: 20157309 PMCID: PMC4212809 DOI: 10.1038/mp.2010.5] [Citation(s) in RCA: 202] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- A Danese
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, London, UK,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King’s College London, London, UK
| | - A Caspi
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, London, UK,Departments of Psychology and Neuroscience, Psychiatry and Behavioral Sciences, and Institute for Genome Sciences and Policy, Duke University, Durham, NC, USA
| | - B Williams
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, London, UK,Departments of Psychology and Neuroscience, Psychiatry and Behavioral Sciences, and Institute for Genome Sciences and Policy, Duke University, Durham, NC, USA
| | - A Ambler
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, London, UK
| | - K Sugden
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, London, UK,Departments of Psychology and Neuroscience, Psychiatry and Behavioral Sciences, and Institute for Genome Sciences and Policy, Duke University, Durham, NC, USA
| | - J Mika
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, London, UK
| | - H Werts
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, London, UK
| | - J Freeman
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, London, UK
| | - CM Pariante
- Department of Psychological Medicine, Institute of Psychiatry, King’s College London, London, UK
| | - TE Moffitt
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, London, UK,Departments of Psychology and Neuroscience, Psychiatry and Behavioral Sciences, and Institute for Genome Sciences and Policy, Duke University, Durham, NC, USA
| | - L Arseneault
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, London, UK
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103
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Morrison JA, Glueck CJ, Daniels SR, Wang P, Stroop DM, Horn PS. High-sensitivity C reactive protein: associations with cardiovascular risk factors and tracking in female adolescents and young adults. ISRN PEDIATRICS 2011; 2011:707206. [PMID: 22482065 PMCID: PMC3317078 DOI: 10.5402/2011/707206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 12/30/2010] [Indexed: 11/23/2022]
Abstract
Objective. We assessed adolescent anthropometry, lipids, insulin, glucose, and blood pressures to identify factors associated with high-sensitivity C-reactive protein (hsCRP) and its tracking in young adults. Methods. Ten-year prospective study of 589 schoolgirls, 321 black, 268 white. Results. HsCRP did not differ (P > .08) by race or oral contraceptive use. HsCRP tracked from age 16 to 25 (r = 0.77), 16 to 26 (r = 0.50), 24 to 26 (r = 0.66), and 25 to 26 (r = 0.71), all P ≤ .02. By stepwise regression, at age 16, waist circumference accounted for 44.8% of hsCRP variance; BMI accounted for 33.1%, 34.4%, and 31.1% at ages 24, 25, and 26, P < .0001 for all. Changes in cholesterol and BMI were associated with change in hsCRP from age 24-26 (partial R(2) = 12.3% P < .0001, 6.6% P = .0012). Changes in BMI and triglyceride (partial R(2) = 8.5% P = .0001, 3.3%, P = .0045) were associated with change in hsCRP from age 25 to 26. Conclusions. HsCRP tracks from age 16 to 26, with BMI, waist circumference, and cholesterol as major determinants.
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Affiliation(s)
- John A Morrison
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA
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104
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DeBoer MD, Gurka MJ. Ability among adolescents for the metabolic syndrome to predict elevations in factors associated with type 2 diabetes and cardiovascular disease: data from the national health and nutrition examination survey 1999-2006. Metab Syndr Relat Disord 2010; 8:343-53. [PMID: 20698802 DOI: 10.1089/met.2010.0008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE The aim of this study was to compare currently proposed sets of pediatric metabolic syndrome criteria for the ability to predict elevations in "surrogate" factors that are associated with metabolic syndrome and with future cardiovascular disease and type 2 diabetes mellitus. These surrogate factors were fasting insulin, hemoglobin A1c (HbA1c), high-sensitivity C-reactive protein (hsCRP), and uric acid. METHODS Waist circumference (WC), blood pressure, triglycerides, high-density lipoprotein cholesterol (HDL-C), fasting glucose, fasting insulin, HbA1c, hsCRP, and uric acid measurements were obtained from 2,624 adolescent (12-18 years old) participants of the 1999-2006 National Health and Nutrition Examination Surveys. We identified children with metabolic syndrome as defined by six commonly used sets of pediatric metabolic syndrome criteria. We then defined elevations in the surrogate factors as values in the top 5% for the cohort and calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for each set of metabolic syndrome criteria and for each surrogate factor. RESULTS Current pediatric metabolic syndrome criteria exhibited variable sensitivity and specificity for surrogate predictions. Metabolic syndrome criteria had the highest sensitivity for predicting fasting insulin (40-70%), followed by uric acid (31-54%), hsCRP (13-31%), and HbA1c (7-21%). The criteria of de Ferranti (which includes children with WC >75(th) percentile, compared to all other sets including children with WC >90(th) percentile) exhibited the highest sensitivity for predicting each of the surrogates, with only modest decrease in specificity compared to the other sets of criteria. However, the de Ferranti criteria also exhibited the lowest PPV values. Conversely, the pediatric International Diabetes Federation criteria exhibited the lowest sensitivity and the highest specificity. CONCLUSIONS Pediatric metabolic syndrome criteria exhibit moderate sensitivity for detecting elevations in surrogate factors associated with metabolic syndrome and with risk for future disease. Inclusion of children with more modestly elevated WC improved sensitivity.
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Affiliation(s)
- Mark D DeBoer
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, USA.
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105
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Singhal N, Misra A, Shah P, Gulati S, Bhatt S, Sharma S, Pandey RM. Impact of intensive school-based nutrition education and lifestyle interventions on insulin resistance, β-cell function, disposition index, and subclinical inflammation among Asian Indian adolescents: a controlled intervention study. Metab Syndr Relat Disord 2010; 9:143-50. [PMID: 21118028 DOI: 10.1089/met.2010.0094] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The present study was designed to assess the impact of intensive and repetitive nutrition education and lifestyle interventions on insulin resistance, β-cell function, disposition index (DI), and subclinical inflammation in Asian Indian adolescents (15-17 years) residing in North India. METHOD In this prospective study, two matched schools were randomly allocated to the intervention (n = 56; 31 boys and 25 girls) or control group (n = 50; 30 boys and 20 girls). The intervention consisted of seven components: (1) Dissemination of health-related information through lectures and focused group discussions, (2) planning of activities such as quizzes, (3) individual counseling of students, (4) promotion of physical activity, (5) change in the canteen menu to healthier alternatives, (6) conducting health camps involving parents and teachers, and (7) training of student volunteers for sustainability of the program in school. Impact of intervention was studied on surrogate markers of insulin resistance, β-cell function, disposition index, and subclinical inflammation. RESULTS At 6 months follow-up, significantly higher (P = 0.037) mean value of homeostasis model assessment denoting β-cell function (HOMA-βCF) was seen in the intervention group compared to the control group, whereas high sensitivity C-reactive protein (hs-CRP) was significantly lowered (P < 0.001). The increase (30.3 ± 73.4; P < 0.037) observed in the DI in adolescents in the intervention group was significantly higher compared to the control group. The Pearson's coefficient of correlation in the intervention group showed that the Δ-decrease in mean waist circumference was significantly correlated (r = 0.267, P < 0.05) with Δ-decrease in homeostasis model assessment of insulin resistance (HOMA-IR). CONCLUSION The intervention model developed by us could be used for amelioration of insulin resistance with potential of preventing type 2 diabetes mellitus in Asian Indian adolescents.
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Affiliation(s)
- Neha Singhal
- National Diabetes, Obesity and Cholesterol Foundation, SDA, New Delhi, India
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106
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Are we there yet? Pediatric screening for inflammatory biomarkers and low cardiorespiratory fitness to identify youth at increased risk of cardiovascular disease. J Adolesc Health 2010; 47:319-21. [PMID: 20863999 DOI: 10.1016/j.jadohealth.2010.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Accepted: 07/30/2010] [Indexed: 11/21/2022]
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107
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Mattsson N, Magnussen CG, Rönnemaa T, Mallat Z, Benessiano J, Jula A, Taittonen L, Kähönen M, Juonala M, Viikari JS, Raitakari OT. Metabolic Syndrome and Carotid Intima-Media Thickness in Young Adults: Roles of Apolipoprotein B, Apolipoprotein A-I, C-Reactive Protein, and Secretory Phospholipase A2: The Cardiovascular Risk in Young Finns Study. Arterioscler Thromb Vasc Biol 2010; 30:1861-6. [DOI: 10.1161/atvbaha.110.204669] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Noora Mattsson
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (N.M., C.M., M.J., O.T.R.) and Departments of Clinical Physiology (O.T.R.) and Medicine (J.S.A.V., T.R., M.J.), University of Turku and Turku University Hospital, Finland; National Institute for Health and Welfare, Finland (A.J.); Vaasa Central Hospital, Finland (L.T.); Department of Clinical Physiology, University of Tampere and Tampere University Hospital, Finland (M.K.); Paris Cardiovascular Research Center, Institut
| | - Costan G. Magnussen
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (N.M., C.M., M.J., O.T.R.) and Departments of Clinical Physiology (O.T.R.) and Medicine (J.S.A.V., T.R., M.J.), University of Turku and Turku University Hospital, Finland; National Institute for Health and Welfare, Finland (A.J.); Vaasa Central Hospital, Finland (L.T.); Department of Clinical Physiology, University of Tampere and Tampere University Hospital, Finland (M.K.); Paris Cardiovascular Research Center, Institut
| | - Tapani Rönnemaa
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (N.M., C.M., M.J., O.T.R.) and Departments of Clinical Physiology (O.T.R.) and Medicine (J.S.A.V., T.R., M.J.), University of Turku and Turku University Hospital, Finland; National Institute for Health and Welfare, Finland (A.J.); Vaasa Central Hospital, Finland (L.T.); Department of Clinical Physiology, University of Tampere and Tampere University Hospital, Finland (M.K.); Paris Cardiovascular Research Center, Institut
| | - Ziad Mallat
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (N.M., C.M., M.J., O.T.R.) and Departments of Clinical Physiology (O.T.R.) and Medicine (J.S.A.V., T.R., M.J.), University of Turku and Turku University Hospital, Finland; National Institute for Health and Welfare, Finland (A.J.); Vaasa Central Hospital, Finland (L.T.); Department of Clinical Physiology, University of Tampere and Tampere University Hospital, Finland (M.K.); Paris Cardiovascular Research Center, Institut
| | - Joelle Benessiano
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (N.M., C.M., M.J., O.T.R.) and Departments of Clinical Physiology (O.T.R.) and Medicine (J.S.A.V., T.R., M.J.), University of Turku and Turku University Hospital, Finland; National Institute for Health and Welfare, Finland (A.J.); Vaasa Central Hospital, Finland (L.T.); Department of Clinical Physiology, University of Tampere and Tampere University Hospital, Finland (M.K.); Paris Cardiovascular Research Center, Institut
| | - Antti Jula
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (N.M., C.M., M.J., O.T.R.) and Departments of Clinical Physiology (O.T.R.) and Medicine (J.S.A.V., T.R., M.J.), University of Turku and Turku University Hospital, Finland; National Institute for Health and Welfare, Finland (A.J.); Vaasa Central Hospital, Finland (L.T.); Department of Clinical Physiology, University of Tampere and Tampere University Hospital, Finland (M.K.); Paris Cardiovascular Research Center, Institut
| | - Leena Taittonen
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (N.M., C.M., M.J., O.T.R.) and Departments of Clinical Physiology (O.T.R.) and Medicine (J.S.A.V., T.R., M.J.), University of Turku and Turku University Hospital, Finland; National Institute for Health and Welfare, Finland (A.J.); Vaasa Central Hospital, Finland (L.T.); Department of Clinical Physiology, University of Tampere and Tampere University Hospital, Finland (M.K.); Paris Cardiovascular Research Center, Institut
| | - Mika Kähönen
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (N.M., C.M., M.J., O.T.R.) and Departments of Clinical Physiology (O.T.R.) and Medicine (J.S.A.V., T.R., M.J.), University of Turku and Turku University Hospital, Finland; National Institute for Health and Welfare, Finland (A.J.); Vaasa Central Hospital, Finland (L.T.); Department of Clinical Physiology, University of Tampere and Tampere University Hospital, Finland (M.K.); Paris Cardiovascular Research Center, Institut
| | - Markus Juonala
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (N.M., C.M., M.J., O.T.R.) and Departments of Clinical Physiology (O.T.R.) and Medicine (J.S.A.V., T.R., M.J.), University of Turku and Turku University Hospital, Finland; National Institute for Health and Welfare, Finland (A.J.); Vaasa Central Hospital, Finland (L.T.); Department of Clinical Physiology, University of Tampere and Tampere University Hospital, Finland (M.K.); Paris Cardiovascular Research Center, Institut
| | - Jorma S.A. Viikari
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (N.M., C.M., M.J., O.T.R.) and Departments of Clinical Physiology (O.T.R.) and Medicine (J.S.A.V., T.R., M.J.), University of Turku and Turku University Hospital, Finland; National Institute for Health and Welfare, Finland (A.J.); Vaasa Central Hospital, Finland (L.T.); Department of Clinical Physiology, University of Tampere and Tampere University Hospital, Finland (M.K.); Paris Cardiovascular Research Center, Institut
| | - Olli T. Raitakari
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (N.M., C.M., M.J., O.T.R.) and Departments of Clinical Physiology (O.T.R.) and Medicine (J.S.A.V., T.R., M.J.), University of Turku and Turku University Hospital, Finland; National Institute for Health and Welfare, Finland (A.J.); Vaasa Central Hospital, Finland (L.T.); Department of Clinical Physiology, University of Tampere and Tampere University Hospital, Finland (M.K.); Paris Cardiovascular Research Center, Institut
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108
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Kang DH, Rice M, Park NJ, Turner-Henson A, Downs C. Stress and inflammation: a biobehavioral approach for nursing research. West J Nurs Res 2010; 32:730-60. [PMID: 20624936 DOI: 10.1177/0193945909356556] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Despite known advantages, the use of biobehavioral approaches in nursing research remains limited. The purposes of this article are to (1) present applications of stress and inflammation in various health conditions as examples of biobehavioral concepts and (2) stimulate similar applications of biobehavioral concepts in future nursing research. Under a biobehavioral conceptual framework, studies on stress and selective inflammatory biomarkers in cardiovascular, cancer, and pulmonary health are reviewed and summarized. Inflammation underlies many diseases, and stress is a significant source of increased inflammation. Biobehavioral concepts of stress and inflammation are highly relevant to nursing research concerned with health-related issues. Diverse biobehavioral concepts are readily applicable and should be utilized in nursing research with children and adults. To stimulate further biobehavioral research, more training and resources for nurse scientists, more unified conceptual definitions and biobehavioral conceptual frameworks, rigorous and expanded methodologies, and more collaboration are essential.
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Affiliation(s)
- Duck-Hee Kang
- University of Texas Health Science Center, Houston, TX 77030, USA.
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109
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Paz-Filho G, Licinio J, Wong ML. Pathophysiological basis of cardiovascular disease and depression: a chicken-and-egg dilemma. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2010; 32:181-91. [PMID: 20658057 PMCID: PMC4259495 DOI: 10.1590/s1516-44462010000200015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 03/10/2010] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To describe the pathophysiological basis linking cardiovascular disease (CVD) and depression; to discuss the causal relationship between them, and to review the effects of antidepressant treatment on cardiovascular disease. METHOD A review of the literature based on the PubMed database. DISCUSSION Depression and cardiovascular disease are both highly prevalent. Several studies have shown that the two are closely related. They share common pathophysiological etiologies or co-morbidities, such as alterations in the hypothalamic-pituitary axis, cardiac rhythm disturbances, and hemorheologic, inflammatory and serotoninergic changes. Furthermore, antidepressant treatment is associated with worse cardiac outcomes (in case of tricyclics), which are not observed with selective serotonin reuptake inhibitors. CONCLUSION Although there is a strong association between depression and cardiovascular disease, it is still unclear whether depression is actually a causal factor for CVD, or is a mere consequence, or whether both conditions share a common pathophysiological etiology. Nevertheless, both conditions must be treated concomitantly. Drugs other than tricyclics must be used, when needed, to treat the underlying depression and not as mere prophylactic of cardiac outcomes.
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Affiliation(s)
- Gilberto Paz-Filho
- The John Curtin School of Medical Research, Australian National University, Canberra, Australia
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110
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Thomas NE, Jasper M, Williams DRR, Rowe DA, Malina RM, Davies B, Siegel SR, Baker JS. Secular trends in established and novel cardiovascular risk factors in Welsh 12-13 year olds: a comparison between 2002 and 2007. Ann Hum Biol 2010; 38:22-7. [PMID: 20450386 DOI: 10.3109/03014460.2010.482540] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study examines CVD risk factors trends in Welsh adolescents between 2002 and 2007. PARTICIPANTS AND METHODS CVD risk factor data was examined from two cross-sectional studies. The first study (73 participants; aged 12.9 ± 0.3 years) was completed in 2002. The second study (90 participants; aged 12.9 ± 0.4 years) was conducted in 2007. Measurements included body mass index (BMI), waist circumference (WC), total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride, fibrinogen (Fg) and high-sensitivity C-reactive protein (hs-CRP). RESULTS In boys, mean BMI and WC were lower in 2007, although not significantly (p ≥ 0.05). In 2007, there were improvements in mean lipid, Fg and hs-CRP concentrations in both sexes (p < 0.05). In 2002, 42.8% of boys and 34.2% of girls were overweight or obese; in 2007, this was 23.7% and 28.9% for boys and girls, respectively. More adolescents in 2002 exceeded the recommended levels for lipids, Fg and hs-CRP. CONCLUSION This is the only study to examine CVD risk factor trends in Welsh adolescents. Although overweight continues to be widespread in 12-13 year olds, this study did not identify significant mean changes in overweight and obesity between 2002 and 2007. Overall, the data presented a positive trend in lipid profile and inflammatory factors.
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Affiliation(s)
- N E Thomas
- Centre for Children and Young Peoples' Health and Well-Being, School of Medicine, Swansea University, Singleton Park, Swansea, Wales, UK.
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111
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Holmes MV, Jiang B, McNeill K, Wong M, Oakley SP, Kirkham B, Chowienczyk PJ. Paradoxical association of C-reactive protein with endothelial function in rheumatoid arthritis. PLoS One 2010; 5:e10242. [PMID: 20436910 PMCID: PMC2860503 DOI: 10.1371/journal.pone.0010242] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2009] [Accepted: 03/25/2010] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Within the general population, levels of C-reactive protein (CRP) are positively associated with atherosclerotic cardiovascular disease (CVD). Whether CRP is causally implicated in atherogenesis or is the results of atherosclerosis is disputed. A role of CRP to protect endothelium-derived nitric oxide (EDNO) has been suggested. We examined the association of CRP with EDNO-dependent vasomotor function and subclinical measures of atherosclerosis and arteriosclerosis in patients with raised CRP resulting from rheumatoid arthritis (RA). METHODOLOGY/PRINCIPAL FINDINGS Patients with RA (n = 59) and healthy control subjects (n = 123), underwent measures of high sensitivity CRP, flow-mediated dilation (FMD, dependent on EDNO), intima-media thickness (IMT, a measure of subclinical atherosclerosis) and aortic pulse wave velocity (PWV, a measure of arteriosclerosis). IMT and PWV were elevated in patients with RA compared to controls but FMD was similar in the two groups. In patients with RA, IMT and PWV were not correlated with CRP but FMD was positively independently correlated with CRP (P<0.01). CONCLUSIONS/SIGNIFICANCE These findings argue against a causal role of CRP in atherogenesis and are consistent with a protective effect of CRP on EDNO bioavailability.
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Affiliation(s)
- Michael V. Holmes
- King's College London, British Heart Foundation Centre, Department of Clinical Pharmacology, St. Thomas' Hospital, London, United Kingdom
| | - Benyu Jiang
- King's College London, British Heart Foundation Centre, Department of Clinical Pharmacology, St. Thomas' Hospital, London, United Kingdom
| | - Karen McNeill
- King's College London, British Heart Foundation Centre, Department of Clinical Pharmacology, St. Thomas' Hospital, London, United Kingdom
| | - Melinda Wong
- King's College London, British Heart Foundation Centre, Department of Clinical Pharmacology, St. Thomas' Hospital, London, United Kingdom
| | - Stephen P. Oakley
- Department of Rheumatology, Guy's and St. Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Bruce Kirkham
- Department of Rheumatology, Guy's and St. Thomas' National Health Service Foundation Trust, London, United Kingdom
- National Institute for Health Research, Guy's and St. Thomas' National Health Service Foundation Trust, King's College London Biomedical Research Centre, London, United Kingdom
| | - Phil J. Chowienczyk
- King's College London, British Heart Foundation Centre, Department of Clinical Pharmacology, St. Thomas' Hospital, London, United Kingdom
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Donald AE, Charakida M, Falaschetti E, Lawlor DA, Halcox JP, Golding J, Hingorani AD, Smith GD, Deanfield JE. Determinants of vascular phenotype in a large childhood population: the Avon Longitudinal Study of Parents and Children (ALSPAC). Eur Heart J 2010; 31:1502-10. [PMID: 20421227 DOI: 10.1093/eurheartj/ehq062] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
AIMS To assess the feasibility and reproducibility of non-invasive vascular assessment in a childhood population setting and identify the determinants of vascular phenotype in early life. METHODS AND RESULTS We studied 7557 children (age 9.8-12.3 years) participating in the Avon Longitudinal Study of Parents and Children (ALSPAC). Six research technicians underwent a 5-month training protocol to enable study of brachial artery endothelial function by flow-mediated dilatation (FMD) and arterial stiffness by carotid to radial pulse wave velocity (PWV) and brachial distensibility [distensibility coefficient (DC)]. Reproducibility studies were performed at the beginning, the middle, and the end of the study. A blinded repeat evaluation of a random selection of 3% of the cohort was also undertaken throughout the study. The effect of anthropometric and environmental factors on each measure was examined. Successful measures were obtained in 88, 95, and 87% of the studied children for FMD, PWV, and DC, respectively. The coefficients of variation between technicians for FMD, PWV, and DC were 10.5, 4.6, and 6.6% at the beginning of the study and reached 7.7, 4.1, and 10% at the end. Baseline vessel diameter and gender were important determinants of all the vascular measures, with a small effect of room and skin temperatures on FMD and PWV. Boys consistently had lower FMD and DC and higher PWV measures (P < 0.01 for all). CONCLUSION Reproducible, high-quality assessments of vascular structure and function in children can be made on a large scale in field studies by suitably trained non-specialist operators. This study provides an invaluable resource for assessing the impact of early influences, genetic, and environmental factors on arterial phenotype.
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Affiliation(s)
- Ann E Donald
- Vascular Physiology Unit, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
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113
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Nelson KB, Richardson AK, He J, Lateef TM, Khoromi S, Merikangas KR. Headache and biomarkers predictive of vascular disease in a representative sample of US children. ACTA ACUST UNITED AC 2010; 164:358-62. [PMID: 20368489 DOI: 10.1001/archpediatrics.2010.17] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To examine the association of childhood headache disorders with markers of risk for cardiovascular and cerebrovascular disease. DESIGN Information was collected on severe or recurrent headache or migraine in childhood or adolescence and on biomarkers predictive of vascular disease. SETTING The National Health and Nutrition Survey, a nationally representative health survey. PARTICIPANTS Children or adolescents aged 4 to 19 years (n = 11 770) who took part in the National Health and Nutrition Survey in 1999 through 2004. MAIN EXPOSURE Headache. MAIN OUTCOME MEASURES Body mass index; levels of C-reactive protein, homocysteine, serum and red blood cell folate, vitamin B(12), methylmalonic acid, total cholesterol, high-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, triglycerides, and uric acid; and platelet count. RESULTS Mean values for body mass index, C-reactive protein, and homocysteine were higher in children with than without headaches, and more children with headaches were in the highest quintile of risk for these factors. Serum and red blood cell folate levels were lower in children with headache. More children with headache were in the highest quintile of risk for 3 or more of these factors. CONCLUSIONS Several important risk factors for long-term vascular morbidity cluster in children and adolescents with severe or recurrent headache or migraine. Further study and screening of children with headaches may permit improved preventive management.
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Affiliation(s)
- Karin B Nelson
- National Institute of Neurological Disorders and Stroke, Bldg 31, Room 8A03, Bethesda, MD 20892-2450, USA.
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114
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Mittelman SD, Gilsanz P, Mo AO, Wood J, Dorey F, Gilsanz V. Adiposity predicts carotid intima-media thickness in healthy children and adolescents. J Pediatr 2010; 156:592-7.e2. [PMID: 20004913 DOI: 10.1016/j.jpeds.2009.10.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Revised: 09/03/2009] [Accepted: 10/14/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine whether anthropometric measurements, blood pressure (BP), fasting total cholesterol, and low-density lipoprotein are related to ultrasound measures of carotid intima-media thickness (CIMT) in children and teenagers with no known risk factors for cardiovascular disease. STUDY DESIGN This cross-sectional study included 599 subjects, 6 to 20 years of age (292 males, 307 females; 224 Hispanics, 210 European-Americans, 126 African-Americans, and 39 Asian-Americans) whose body mass index, waist circumference, BP, lipid profiles, and values for CIMT were determined. RESULTS Measures of CIMT were significantly greater in males than females (P=.006) and in African-Americans when compared with other ethnic groups (all P < .05). There were no relations between age, diastolic BP, or fasting levels of triglycerides, total cholesterol, or low-density lipoprotein values and CIMT measures, regardless of sex or ethnic background. Stratified multiple regression analysis indicated that body mass index and waist circumference independently predicted CIMT in both males and females, even after controlling for age, weight, BP, fasting lipid levels, and ethnic background. CONCLUSION Increased body mass and adiposity are associated with increased intima-media thickness in children and teenagers. This association is present in children not considered overweight, underscoring the need for the continued promotion of adequate nutritional and physical exercise behavior during childhood.
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Affiliation(s)
- Steven D Mittelman
- Department of Pediatrics, Division of Endocrinology, Diabetes & Metabolism, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA
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115
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Hypercholesterolemia in Youth: Opportunities and Obstacles to Prevent Premature Atherosclerotic Cardiovascular Disease. Curr Atheroscler Rep 2010; 12:20-8. [DOI: 10.1007/s11883-009-0072-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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116
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Pirkola J, Vääräsmäki M, Ala-Korpela M, Bloigu A, Canoy D, Hartikainen AL, Leinonen M, Miettola S, Paldanius M, Tammelin TH, Järvelin MR, Pouta A. Low-grade, systemic inflammation in adolescents: association with early-life factors, gender, and lifestyle. Am J Epidemiol 2010; 171:72-82. [PMID: 19917553 DOI: 10.1093/aje/kwp320] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Low-grade, systemic inflammation is related to increased risk of cardiovascular disease in adults. The proinflammatory state tracks from adolescence to adulthood. Identifying correlates of inflammation in adolescents could provide opportunities to prevent cardiovascular disease in adulthood. However, population-based data on correlates of inflammation in adolescence are limited. Therefore, the authors studied the associations of early-life factors, gender, and lifestyle with inflammation (measured by high-sensitivity C-reactive protein and leukocyte count) at age 16 years (2001-2002) in the prospective, population-based Northern Finland Birth Cohort 1986 Study (n = 5,240). In females, being born small for gestational age and current use of oral contraceptives were associated with the proinflammatory state. The association of birth size with inflammation was not observed in males. In logistic regression analyses, oral contraceptive use (odds ratio (OR) = 2.83), abdominal obesity (OR = 5.17), and smoking (OR = 2.72) were associated with elevation of both inflammation markers in females; abdominal obesity (OR = 5.72) and smoking (OR = 2.02) were associated in males. Thus, females appear more susceptible to the adverse effects of being born small for gestational age than males. Given the widespread use of oral contraceptives and the potential pathophysiologic consequences of the proinflammatory state, the association of oral contraceptive use with inflammation in adolescence may have public health implications.
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Affiliation(s)
- Jatta Pirkola
- Department of Obstetrics and Gynecology, Oulu University Hospital, P.O. Box 24, FI-90029 Oulu, Finland.
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117
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Labayen I, Ortega FB, Sjöström M, Ruiz JR. Early life origins of low-grade inflammation and atherosclerosis risk in children and adolescents. J Pediatr 2009; 155:673-7. [PMID: 19595364 DOI: 10.1016/j.jpeds.2009.04.056] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Revised: 04/01/2009] [Accepted: 04/24/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the relationship between birth weight and later low-grade inflammation in children and adolescents. STUDY DESIGN We selected 166 children (49.4% boys; aged, 9.5 +/- 0.3 years) and 126 adolescents (43.7% males; aged, 15.5 +/- 0.4 years) from the Swedish part of the European Youth Heart Study. Birth weight data were collected from parental recall. Low-grade inflammatory markers include C-reactive protein, fibrinogen, and complement factors C3 and C4. Fatness was measured by the sum of 5 skinfold thicknesses. Cardiorespiratory fitness was measured with a maximal ergometer bike test. The association between birth weight and low-grade inflammatory markers was examined with multiple regression analyses. RESULTS Birth weight was negatively associated with fibrinogen (beta = -0.059; P = .036), C3 (beta = -0.019; P = .010), and C4 (beta = -0.024; P = .031), after controlling for sex, pubertal status, mother's body mass index and socioeconomic status, fatness and fitness. Birth weight was not associated to later C-reactive protein level (all P > .1). CONCLUSIONS Our results showed that smaller birth weight is associated with chronic low-grade inflammation in children and adolescents. Because of the implication of complement factors on atherosclerosis process, these results contribute to explain the increased cardiovascular risk associated with low birth weight.
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Affiliation(s)
- Idoia Labayen
- Department of Nutrition and Food Science, University of the Basque Country, Vitoria, Spain.
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118
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Qureshi MM, Singer MR, Moore LL. A cross-sectional study of food group intake and C-reactive protein among children. Nutr Metab (Lond) 2009; 6:40. [PMID: 19822004 PMCID: PMC2770558 DOI: 10.1186/1743-7075-6-40] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 10/12/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND C-reactive protein (CRP), a marker of sub-clinical inflammation, is a predictor of future cardiovascular diseases. Dietary habits affect serum CRP level however the relationship between consumption of individual food groups and CRP levels has not been established. METHODS This study was designed to explore the relation between food intake and CRP levels in children using data from the cross-sectional 1999-2002 National Health and Nutrition Examination Surveys. CRP level was classified as low, average or high (<1.0, 1.0-3.0, and >3.0 mg/L, respectively). Adjusted mean daily intakes of dairy, grains, fruit, vegetables, and meat/other proteins in each CRP category were estimated using multivariate analysis of covariance modeling. The effect modification by age (5-11 years vs. 12-16 years), gender and race/ethnicity was explored. We examined whether total or central body fat (using BMI Z-scores and waist circumference) explained any of the observed associations. RESULTS A total of 4,010 children and adolescents had complete information on diet, CRP and all covariates of interest and were included in the analyses. Individuals with high CRP levels had significantly lower intake of grains (p < 0.001) and vegetables (p = 0.0002). Selected individual food subgroups (e.g., fluid milk and "citrus, melon and berry" consumption) were more strongly associated with lower CRP than were their respective major food groups. Consumption of meat/other proteins did not influence CRP levels. The addition of body composition variables to the models attenuated the results for all food groups to varying degrees. CONCLUSION Children and adolescents with higher CRP levels had significantly lower intakes of grains and vegetables. The associations between selected childhood dietary patterns and CRP levels seem largely mediated through effects on body composition.
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Affiliation(s)
- M Mustafa Qureshi
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Harrison Court, 761 Harrison Ave, Boston, MA 02118, USA
| | - Martha R Singer
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Harrison Court, 761 Harrison Ave, Boston, MA 02118, USA
| | - Lynn L Moore
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Harrison Court, 761 Harrison Ave, Boston, MA 02118, USA
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119
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Komurcu-Bayrak E, Erginel-Unaltuna N, Onat A, Ozsait B, Eklund C, Hurme M, Mononen N, Laaksonen R, Hergenc G, Lehtimäki T. Association of C-reactive protein (CRP) gene allelic variants with serum CRP levels and hypertension in Turkish adults. Atherosclerosis 2009; 206:474-9. [DOI: 10.1016/j.atherosclerosis.2009.03.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Revised: 03/25/2009] [Accepted: 03/29/2009] [Indexed: 11/25/2022]
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120
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Castro C, Tracy RP, Deckelbaum RJ, Basch CE, Shea S. Adiposity is associated with endothelial activation in healthy 2-3 year-old children. J Pediatr Endocrinol Metab 2009; 22:905-14. [PMID: 20020578 PMCID: PMC3603688 DOI: 10.1515/jpem.2009.22.10.905] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Adiposity is associated with C-reactive protein level in healthy 2-3 year-old children and with other markers of endothelial activation in adults, but data are lacking in very young children. Data from 491 healthy Hispanic children were analyzed. Mean age was 2.7 years (SD 0.5, range 2-3 years); mean body mass index (BMI) was 17.2 kg/m2 (SD 1.9) among boys and 17.1 kg/m2 (SD 2.1) among girls. E-selectin level was associated with BMI (R = 0.11; p < 0.02), ponderal index (p < 0.02), waist circumference (p = 0.02), fasting insulin (p < 0.02), and insulin resistance (p < or = 0.05); these associations remained significant after adjustment for age, sex and fasting glucose. sVCAM was also associated with BMI (R = 0.12; p < 0.05). These observations indicate that adiposity is associated with inflammation and endothelial activation in very early childhood.
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Affiliation(s)
- Cecilia Castro
- Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY, USA
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121
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Pesonen E, El-Segaier M, Persson K, Puolakkainen M, Sarna S, Ohlin H, Pussinen PJ. Infections as a stimulus for coronary occlusion, obstruction, or acute coronary syndromes. Ther Adv Cardiovasc Dis 2009; 3:447-54. [PMID: 19773293 DOI: 10.1177/1753944709345598] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Atherosclerosis is considered to be an inflammatory disease. Infections are a significant cause of inflammation. Acute infections might precipitate acute coronary syndromes (ACS) whereas chronic infections might be stimuli for the development of atherosclerosis. METHODS Coronary angiograms were done on 211 of 335 patients with ACS and the percentage of coronary obstruction was determined. Serum antibody levels to Chlamydia pneumoniae, C. pneumoniae heat shock protein 60 (CpnHSP60), human heat shock protein 60 (hHSP60), enterovirus (EV), herpes simplex virus (HSV), cytomegalovirus (CMV), and two major periodontal pathogens, Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis, were measured in healthy controls (n = 355) and all patients. RESULTS Serum antibody levels to periodontal pathogens did not correlate with ACS. However, IgA-class antibody levels to Aggregatibacter actinomycetemcomitans (p = 0.021), CpnHSP60 (p = 0.048) an hHSP60 (p = 0.038) were higher in patients with coronary occlusion or obstruction compared to those without any obstruction. Odds ratios for coronary changes in the highest quartile as compared to the lower quartiles were for A. actinomycetemcomitans IgA 7.84 (95% CI 1.02-60.39, p = 0.048), for CpnHSP60 IgA 8.61 (1.12-65.89, p = 0.038), and for human HSP60 IgA 3.51 (0.79-15.69, p = 0.100). CONCLUSIONS We have previously reported that EV and HSV titres correlated significantly to acute coronary events. They do not correlate to the degree of coronary obstruction as shown here. However, infection by A. actinomycetemcomitans or C. pneumoniae or host response against them associated with coronary obstruction. Clinical coronary events may arise by the effect of acute infections and obstructing lesions by a chronic inflammatory stimulus.
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Affiliation(s)
- Erkki Pesonen
- Pediatric Cardiology, University Hospital of Lund, Lund, Sweden.
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122
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Urbina EM, Williams RV, Alpert BS, Collins RT, Daniels SR, Hayman L, Jacobson M, Mahoney L, Mietus-Snyder M, Rocchini A, Steinberger J, McCrindle B. 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. [PMID: 19729599 DOI: 10.1161/hypertensionaha.109.192639] [Citation(s) in RCA: 467] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Deterioration in endothelial function and arterial stiffness are early events in the development of cardiovascular diseases. In adults, noninvasive measures of atherosclerosis have become established as valid and reliable tools for refining cardiovascular risk to target individuals who need early intervention. With limited pediatric data, the use of these techniques in children and adolescents largely has been reserved for research purposes. Therefore, this scientific statement was written to (1) review the current literature on the noninvasive assessment of atherosclerosis in children and adolescents, (2) make recommendations for the standardization of these tools for research, and (3) stimulate further research with a goal of developing valid and reliable techniques with normative data for noninvasive clinical evaluation of atherosclerosis in pediatric patients. Precise and reliable noninvasive tests for atherosclerosis in youth will improve our ability to estimate future risk for heart attack and stroke. Currently, large longitudinal studies of cardiovascular risk factors in youth, such as the Bogalusa and Muscatine studies, lack sufficient adult subjects experiencing hard outcomes, such as heart attack and stroke, to produce meaningful risk scores like those developed from Framingham data.
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123
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Labayen I, Ortega FB, Sjöström M, Nilsson TK, Olsson LA, Ruiz JR. Association of common variants of UCP2 gene with low-grade inflammation in Swedish children and adolescents; the European Youth Heart Study. Pediatr Res 2009; 66:350-4. [PMID: 19531977 DOI: 10.1203/pdr.0b013e3181b1bd35] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We examined the associations of two functional variants 866G>A and DEL/INS polymorphisms of UCP2 gene with low-grade inflammatory proteins (C-reactive protein, fibrinogen, complement C3 [C3], and complement C4 [C4]) in 131 children (52.7% boys, aged 9.5 +/- 0.4 y) and 118 adolescents (44.1% males, aged 15.5 +/- 0.4 y) selected from the European Youth Heart Study. Differences in inflammatory markers among the genotype variants of the two UCP2 gene polymorphisms were analyzed after adjusting for sex, age, pubertal stage, fitness, and fatness. The results showed that fibrinogen, C3, and C4 were higher in GG carriers than in subjects carrying the A allele of the 866G>A polymorphism of the UCP2 gene (UCP2 -866G>A) polymorphism (all p < 0.05). The DEL/DEL genotype of 45nt deletion/insertion variant polymorphism of the UCP2 gene (UCP2 DEL/INS) was associated with higher C3 (p < 0.05) than DEL/INS and INS/INS genotypes. This study provides evidence of a role of UCP2 -866G>A in modifying low-grade inflammatory state in apparently healthy children and adolescents. Given the implication of complement factors on atherosclerosis process, these results contribute to explain the reduced cardiovascular risk associated with the A allele of the UCP2 -866G>A polymorphism.
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Affiliation(s)
- Idoia Labayen
- Department of Nutrition and Food Sciences, University of the Basque Country, Vitoria 01006, Spain.
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124
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Evangelista O, McLaughlin MA. Review of cardiovascular risk factors in women. ACTA ACUST UNITED AC 2009; 6 Suppl 1:17-36. [PMID: 19318217 DOI: 10.1016/j.genm.2009.02.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although cardiovascular disease (CVD) is the leading cause of death in women in the United States, a knowledge gap persists regarding the mechanisms and management of CVD in women. Before treatment can be optimized, the role of cardiovascular risk factors must be elucidated. OBJECTIVE This review provides an updated assessment of cardiovascular risk factors in women, with a focus on cardiometabolic risk. METHODS MEDLINE and Cochrane Library databases, and statistics from the National Health and Nutrition Examination Survey and the American Heart Association, were searched from 1990 to September 2008 using the following terms: cardiovascular risk factors, women, gender, cardiometabolic risk, abdominal obesity, and metabolic syndrome. Publications were classified as English-only original data, reviews, and clinical guidelines. Nonpublished data were excluded. Data were extracted by 2 reviewers independently. RESULTS Investigators performing multivariable predictive models have estimated that traditional risk factors account for approximately 70% of the variance in estimating cardiovascular events. However, substantial sex differences exist in the prevalence of traditional risk factors as well as in cardiovascular outcomes. Hypertension is more prevalent in men until the age of 59 years, but then contributes to greater morbidity in older women. Low levels of high-density lipoprotein and elevated triglyceride levels pose more of a threat to women, yet high levels of low-density lipoprotein pose equal risk for women and men. The CVD mortality rate is -3 times greater in people with diabetes than in those without diabetes. Among diabetic individuals, CVD mortality is slightly higher in women compared with men. CONCLUSIONS Increased knowledge of gender-specific risks for CVD has led to national campaigns to educate women. In addition to traditional risk factors, cardiometabolic risk is an important consideration in women. Controversy exists regarding the exact definitions and usefulness of the term metabolic syndrome, but it is clear that the presence of certain factors contributes to increased morbidity and mortality in affected individuals. Abdominal obesity links insulin resistance, dyslipidemia, and hypertension through complex endocrine pathways. Current research is identifying gene x gender interactions, and continued research is necessary to explore the relationship of sex steroids and cardiovascular risk in both men and women.
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Affiliation(s)
- Odette Evangelista
- Department of Medicine, Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York, USA
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125
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Rizk SM, Sabri NA. Evaluation of clinical activity and safety of Daflon 500 mg in type 2 diabetic female patients. Saudi Pharm J 2009; 17:199-207. [PMID: 23964162 PMCID: PMC3731024 DOI: 10.1016/j.jsps.2009.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2008] [Accepted: 05/10/2009] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The incidence of cardiovascular disease in patients with type 2 diabetes mellitus is approximately twice as high as in the non-diabetic population. AIM To investigate the hypoglycemic and hypocholesterolemic effects of Daflon(®) 500 mg (DF) administration together with its tolerability and efficacy in reducing the cardiovascular metabolic risk factors in female patients with type 2 diabetes. METHODS In a well-adequate controlled single-blinded randomized parallel design the tolerability and the efficacy of Daflon(®) (500 mg) either alone or with oral hypoglycemic, twice daily for 45 days, was studied in 36 female patients with type 2 diabetes. RESULTS None of the patients in the studied groups were reported to have any adverse events throughout the treatment period (45 days), liver and kidney function tests were within normal limits and there was no significant difference between the pre-treatment (day 0) and post-treatment (day 45) values. Female patients receiving Daflon(®) either alone or with oral hypoglycemic showed significant decrease in serum glucose; fructosamine; total cholesterol; LDL-cholesterol; triglycerides; malondialdehydes (as index of lipid peroxidation) and C-reactive protein (CRB) levels along with increase in the levels of nitric oxide and blood glutathione. CONCLUSION This study has shown that Daflon(®) (500 mg, twice daily for 45 days) is helpful in reducing glucose level and the risk of cardiovascular disease in type 2 diabetic patients. RECOMMENDATION Further clinical trials are essential for strengthening the evidence base on the role of this drug in the cardiovascular risk in diabetic patients.
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Affiliation(s)
- Sherine Maher Rizk
- Department of Biochemistry, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Nagwa Ali Sabri
- Department of Clinical Pharmacy, Ain Shams University, Cairo, Egypt
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126
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Ayer JG, Harmer JA, Nakhla S, Xuan W, Ng MK, Raitakari OT, Marks GB, Celermajer DS. HDL-Cholesterol, Blood Pressure, and Asymmetric Dimethylarginine Are Significantly Associated With Arterial Wall Thickness in Children. Arterioscler Thromb Vasc Biol 2009; 29:943-9. [DOI: 10.1161/atvbaha.109.184184] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective—
Atherosclerosis is found at autopsy in the arteries of adolescents and young adults. Arterial wall thickening may be assessed in vivo by ultrasound measurement of the carotid intima media thickness (CIMT), a marker of subclinical atherosclerosis. As the determinants of arterial wall thickness in childhood are unknown, we assessed the influence of cardiovascular risk factors on CIMT in 8-year-old children.
Methods and Results—
A community-based sample of 405 children (age 8.0±0.1 years, 49% girls) had anthropometry, family history, blood pressure (BP), and CIMT measured. A blood sample was collected for HDL and non-HDL cholesterol, apolipoproteins A1 and B, high-sensitivity C-reactive protein, bilirubin, and asymmetric dimethylarginine (ADMA, an endogenous nitric oxide inhibitor). CIMT was significantly associated with systolic BP (
r
=0.17,
P
<0.001), diastolic BP (
r
=0.10,
P
=0.04), HDL (
r
=−0.13,
P
=0.02), and ADMA (
r
=0.18,
P
=0.001). CIMT was significantly higher in children with premature parental CHD (0.63±0.07 versus 0.59±0.06 mm,
P
=0.03). On multivariate analysis, HDL (β coefficient=−0.02,
P
=0.04), ADMA (β coefficient=0.05,
P
<0.001), and systolic BP (β coefficient=0.001,
P
=0.003) were significantly and independently associated with CIMT.
Conclusions—
Lower HDL-cholesterol, higher levels of ADMA, and systolic BP are significantly associated with greater arterial wall thickness in early childhood.
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Affiliation(s)
- Julian G. Ayer
- From the Department of Cardiology (J.G.A., J.A.H., M.K.C.N., D.S.C.), Royal Prince Alfred Hospital, Sydney, Australia; the Heart Research Institute (J.G.A., S.N., M.K.C.N., D.S.C.), Sydney, Australia; the Woolcock Institute of Medical Research (W.X., G.B.M.), Sydney, Australia; the Department of Clinical Physiology (O.T.R.), University of Turku, Finland; and the Department of Medicine and Bosch Institute (J.G.A., M.K.C.N., D.S.C.), the University of Sydney, Australia
| | - Jason A. Harmer
- From the Department of Cardiology (J.G.A., J.A.H., M.K.C.N., D.S.C.), Royal Prince Alfred Hospital, Sydney, Australia; the Heart Research Institute (J.G.A., S.N., M.K.C.N., D.S.C.), Sydney, Australia; the Woolcock Institute of Medical Research (W.X., G.B.M.), Sydney, Australia; the Department of Clinical Physiology (O.T.R.), University of Turku, Finland; and the Department of Medicine and Bosch Institute (J.G.A., M.K.C.N., D.S.C.), the University of Sydney, Australia
| | - Shirley Nakhla
- From the Department of Cardiology (J.G.A., J.A.H., M.K.C.N., D.S.C.), Royal Prince Alfred Hospital, Sydney, Australia; the Heart Research Institute (J.G.A., S.N., M.K.C.N., D.S.C.), Sydney, Australia; the Woolcock Institute of Medical Research (W.X., G.B.M.), Sydney, Australia; the Department of Clinical Physiology (O.T.R.), University of Turku, Finland; and the Department of Medicine and Bosch Institute (J.G.A., M.K.C.N., D.S.C.), the University of Sydney, Australia
| | - Wei Xuan
- From the Department of Cardiology (J.G.A., J.A.H., M.K.C.N., D.S.C.), Royal Prince Alfred Hospital, Sydney, Australia; the Heart Research Institute (J.G.A., S.N., M.K.C.N., D.S.C.), Sydney, Australia; the Woolcock Institute of Medical Research (W.X., G.B.M.), Sydney, Australia; the Department of Clinical Physiology (O.T.R.), University of Turku, Finland; and the Department of Medicine and Bosch Institute (J.G.A., M.K.C.N., D.S.C.), the University of Sydney, Australia
| | - Martin K.C. Ng
- From the Department of Cardiology (J.G.A., J.A.H., M.K.C.N., D.S.C.), Royal Prince Alfred Hospital, Sydney, Australia; the Heart Research Institute (J.G.A., S.N., M.K.C.N., D.S.C.), Sydney, Australia; the Woolcock Institute of Medical Research (W.X., G.B.M.), Sydney, Australia; the Department of Clinical Physiology (O.T.R.), University of Turku, Finland; and the Department of Medicine and Bosch Institute (J.G.A., M.K.C.N., D.S.C.), the University of Sydney, Australia
| | - Olli T. Raitakari
- From the Department of Cardiology (J.G.A., J.A.H., M.K.C.N., D.S.C.), Royal Prince Alfred Hospital, Sydney, Australia; the Heart Research Institute (J.G.A., S.N., M.K.C.N., D.S.C.), Sydney, Australia; the Woolcock Institute of Medical Research (W.X., G.B.M.), Sydney, Australia; the Department of Clinical Physiology (O.T.R.), University of Turku, Finland; and the Department of Medicine and Bosch Institute (J.G.A., M.K.C.N., D.S.C.), the University of Sydney, Australia
| | - Guy B. Marks
- From the Department of Cardiology (J.G.A., J.A.H., M.K.C.N., D.S.C.), Royal Prince Alfred Hospital, Sydney, Australia; the Heart Research Institute (J.G.A., S.N., M.K.C.N., D.S.C.), Sydney, Australia; the Woolcock Institute of Medical Research (W.X., G.B.M.), Sydney, Australia; the Department of Clinical Physiology (O.T.R.), University of Turku, Finland; and the Department of Medicine and Bosch Institute (J.G.A., M.K.C.N., D.S.C.), the University of Sydney, Australia
| | - David S. Celermajer
- From the Department of Cardiology (J.G.A., J.A.H., M.K.C.N., D.S.C.), Royal Prince Alfred Hospital, Sydney, Australia; the Heart Research Institute (J.G.A., S.N., M.K.C.N., D.S.C.), Sydney, Australia; the Woolcock Institute of Medical Research (W.X., G.B.M.), Sydney, Australia; the Department of Clinical Physiology (O.T.R.), University of Turku, Finland; and the Department of Medicine and Bosch Institute (J.G.A., M.K.C.N., D.S.C.), the University of Sydney, Australia
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128
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Abstract
BACKGROUND Cultural factors and biomarkers are emerging emphases in social epidemiology that readily ally with human biology and anthropology. Persistent health challenges and disparities have established biocultural roots, and environment plays an integral role in physical development and function that form the bases of population health. Biomarkers have proven to be valuable tools for investigating biocultural bases of health disparities. AIMS We apply recent insights from biology to consider how culture gets under the skin and evaluate the construct of embodiment. We analyse contrasting biomarker models and applications, and propose an integrated model for biomarkers. Three examples from the Great Smoky Mountains Study (GSMS) illustrate these points. SUBJECTS AND METHODS The longitudinal developmental epidemiological GSMS comprises a population-based sample of 1420 children with repeated measures including mental and physical health, life events, household conditions, and biomarkers for pubertal development and allostatic load. RESULTS Analyses using biomarkers resolved competing explanations for links between puberty and depression, identified gender differences in stress at puberty, and revealed interactive effects of birthweight and postnatal adversity on risk for depression at puberty in girls. CONCLUSION An integrated biomarker model can both enrich epidemiology and illuminate biocultural pathways in population health.
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Affiliation(s)
- Carol M Worthman
- Department of Anthropology, Emory University, Atlanta, GA 30322, USA.
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129
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Litwin M, Niemirska A. Intima-media thickness measurements in children with cardiovascular risk factors. Pediatr Nephrol 2009; 24:707-19. [PMID: 18784945 DOI: 10.1007/s00467-008-0962-3] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2008] [Revised: 07/14/2008] [Accepted: 07/15/2008] [Indexed: 12/15/2022]
Abstract
Measuring intima-media thickness (IMT) is now a standard diagnostic procedure in assessing cardiovascular risk and hypertensive target-organ damage (TOD) in adults. There is also an increasing number of pediatric publications evaluating IMT in children from high-risk groups, such as those with arterial hypertension, diabetes, chronic kidney disease, obesity, dyslipidemia, and homocystinurias. It has been shown that carotid IMT is strongly related with other markers of TOD in children with arterial hypertension and with metabolic cardiovascular risk factors. In children with coarctation of the aorta, carotid IMT correlated both with blood pressure and even with mild residual aortic gradient. On the other hand, studies in children with high cardiovascular risk have shown that normalization of blood pressure and metabolic abnormalities led to regression of arterial changes and decrease of IMT. Although not yet accepted as standard pediatric procedure, IMT measurement is emerging as a promising method of assessing TOD and cardiovascular risk and monitoring treatment efficacy. From a practical point of view, clinical utility of IMT measurements seems to be similar to use of echocardiography in assessing left ventricular mass. However, IMT measurements in children and adolescents should be standardized to avoid bias caused by the use of different measurement methods.
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Affiliation(s)
- Mieczysław Litwin
- Department of Research, The Children's Memorial Health Institute, Warsaw, Poland.
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130
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Fruit and vegetable consumption and its relation to markers of inflammation and oxidative stress in adolescents. ACTA ACUST UNITED AC 2009; 109:414-21. [PMID: 19248856 DOI: 10.1016/j.jada.2008.11.036] [Citation(s) in RCA: 293] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Accepted: 09/25/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND Fruits and vegetables, foods rich in flavonoids and antioxidants, have been associated with lower risk of stroke, coronary heart disease, and markers of inflammation and oxidative stress in adults. Markers of inflammation and oxidative stress are predictors of coronary heart disease risk; however, it is unknown whether these markers are related to dietary flavonoid and antioxidant intake in youth. OBJECTIVE To determine whether greater intakes of fruit and vegetables, antioxidants, folate, and total flavonoids were inversely associated with markers of inflammation and oxidative stress in 285 adolescent boys and girls aged 13 to 17 years. DESIGN In this cross-sectional study conducted between February 1996 and January 2000, diet was assessed by a 127-item food frequency questionnaire. Height and weight measurements were obtained and a fasting blood sample drawn. Spearman partial correlation analyses evaluated the relation of intakes of fruit and vegetables, antioxidants, folate, and flavonoids with markers of inflammation (C-reactive protein, interleukin-6, tumor necrosis factor-alpha, and 15-keto-dihydro-PGF(2alpha) metabolite and oxidative stress (urinary 8-iso prostaglandin F(2alpha), an F(2)-isoprostane), adjusting for age, sex, race, Tanner stage, energy intake, and body mass index. RESULTS Urinary F(2)-isoprostane was inversely correlated with intakes of total fruit and vegetables, vitamin C, beta carotene, and flavonoids. Serum C-reactive protein was significantly inversely associated with intakes of fruit (r=-0.19; P=0.004), vitamin C (r=-0.13, P=0.03), and folate (r=-0.18; P=0.004). Serum interleukin-6 was inversely associated with intakes of legumes, vegetables, beta carotene, and vitamin C. Serum tumor necrosis factor-alpha was inversely associated with beta carotene (r=-0.14, P=0.02) and luteolin (r=-0.15, P=0.02). CONCLUSION Study results show that the beneficial effects of fruit and vegetable intake on markers of inflammation and oxidative stress are already present by early adolescence and provide support for the Dietary Guidelines for Americans "to consume five or more servings per day" of fruits and vegetables to promote beneficial cardiovascular health.
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Dalmau Serra J, Vitoria Miñana I, Legarda Tamara M, Muro Velilla D, Sangüesa Nebot C. [Evaluation of carotid intima-media thickness in familial hypercholesterolemia in childhood]. An Pediatr (Barc) 2009; 70:349-53. [PMID: 19282259 DOI: 10.1016/j.anpedi.2008.11.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Revised: 11/27/2008] [Accepted: 11/28/2008] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Familial hypercholesterolemia (FH) is characterized by exposure to severely elevated LDL-cholesterol from birth, which produces lipid deposits, which can be measured by means of intima-media thickness (IMT). SUBJECTS AND METHODS The IMT and concentrations of cholesterol and its fractions, triglycerides, alipoproteins Apo-A1, Apo-B and endothelial risk factors (homocysteine and high sensitivity protein C ) were determined in 89 patients (44 males) from 2 to 19 years (9.54+/-3.91 years). IMT was measured by ultrasound using a 12MHz linear array transducer in both carotids to 1cm of the bulb. The IMT mean was compared with age, sex and analytical parameters using multiple regression analysis. RESULTS The mean values were: IMT 0.334+/-0.088mm, total cholesterol 273.62+/-91.93mg/dl, LDL-cholesterol 204.21+/-86.16mg/dl, LDL/HDL 3.83+/-1.45, apoprotein A1 134.61+/-26.49mg/dl, apoprotein B 130.59+/-40.59mg/dl, homocysteine (median) 7.16mmol/dl, Protein C (median) 0.3mg/l. Using multiple regression analysis, only age was associated with IMT (P=0.049), a mean 0.005mm (95% CI: 0.000-0.010) being the annual increase: up to 12 years the increase in IMT was 0.002mm/year on (95% CI: -0.007-0,010) and then from that age it was 0.013mm/year (95% CI: -0.023-0.049). CONCLUSIONS The measurement of the carotid IMT could become an objective parameter in the evaluation of the FH in childhood. In our study, it is only associated with age, the increase being most marked from 12 years onwards.
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Affiliation(s)
- J Dalmau Serra
- Unidad de Nutrición y Metabolopatías, Hospital Infantil La Fe, Valencia, España.
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132
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Amlie-Lefond C, Bernard TJ, Sébire G, Friedman NR, Heyer GL, Lerner NB, DeVeber G, Fullerton HJ. Predictors of cerebral arteriopathy in children with arterial ischemic stroke: results of the International Pediatric Stroke Study. Circulation 2009; 119:1417-23. [PMID: 19255344 DOI: 10.1161/circulationaha.108.806307] [Citation(s) in RCA: 236] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cerebral arteriopathies, including an idiopathic focal cerebral arteriopathy of childhood (FCA), are common in children with arterial ischemic stroke and strongly predictive of recurrence. To better understand these lesions, we measured predictors of arteriopathy within a large international series of children with arterial ischemic stroke. METHODS AND RESULTS Between January 2003 and July 2007, 30 centers within the International Pediatric Stroke Study enrolled 667 children (age, 29 days to 19 years) with arterial ischemic stroke and abstracted clinical and radiographic data. Cerebral arteriopathy and its subtypes were defined using published definitions; FCA was defined as cerebral arterial stenosis not attributed to specific diagnoses such as moyamoya, arterial dissection, vasculitis, or postvaricella angiopathy. We used multivariate logistic regression techniques to determine predictors of arteriopathy and FCA among those subjects who received vascular imaging. Of 667 subjects, 525 had known vascular imaging results, and 53% of those (n=277) had an arteriopathy. The most common arteriopathies were FCA (n=69, 25%), moyamoya (n=61, 22%), and arterial dissection (n=56, 20%). Predictors of arteriopathy include early school age (5 to 9 years), recent upper respiratory infections, and sickle cell disease, whereas prior cardiac disease and sepsis reduced the risk of arteriopathy. The only predictor of FCA was recent upper respiratory infection. CONCLUSIONS Arteriopathy is prevalent among children with arterial ischemic stroke, particularly those presenting in early school age, and those with a history of sickle cell disease. Recent upper respiratory infection predicted cerebral arteriopathy and FCA in particular, suggesting a possible role for infection in the pathogenesis of these lesions.
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Affiliation(s)
- Catherine Amlie-Lefond
- Department of Neurology, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, USA
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133
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MacKenzie KE, Wiltshire EJ, Peña AS, Gent R, Hirte C, Piotto L, Couper JJ. Hs-CRP is associated with weight, BMI, and female sex but not with endothelial function in children with type 1 diabetes. Pediatr Diabetes 2009; 10:44-51. [PMID: 18798827 DOI: 10.1111/j.1399-5448.2008.00456.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Atherosclerosis is an inflammatory process, and high-sensitivity C-reactive protein (Hs-CRP), a marker of inflammation, predicts cardiovascular events in adults. Vascular endothelial and smooth muscle dysfunction, measurable precursors of atherosclerosis, begin in childhood. Therefore, we sought to determine if Hs-CRP is associated with vascular endothelial and smooth muscle dysfunction in children with type 1 diabetes mellitus (T1DM) and healthy control subjects. METHODS Hs-CRP and endothelial function assessed by flow-mediated dilatation (FMD) and smooth muscle function assessed by glyceryl-trinitrate (GTN)-induced dilatation were measured in 121 subjects with T1DM aged 14.1 (2.9) yr, of whom 31 were also studied at 4 and 8 wk, and in 33 healthy controls aged 14.2 (3.6) yr. RESULTS Hs-CRP did not differ between subjects with T1DM and healthy, age-matched controls. In both controls and subjects with T1DM, Hs-CRP did not relate to FMD or GTN at baseline or at intervals over 8 wk in T1DM. Hs-CRP did not change over time. In T1DM, but not healthy controls, Hs-CRP related to body mass index (BMI) z-score (r = 0.47, p < 0.001), weight z-score (r = 0.41, p < 0.001), and female sex (p = 0.008). CONCLUSIONS Hs-CRP is not associated with early vascular dysfunction in children with T1DM. However, in children and adolescents with T1DM, Hs-CRP was associated with female sex and children with higher BMI, suggesting that these groups may be at greater cardiovascular risk. Maintenance of a healthy BMI may be important in the prevention of vascular disease of T1DM.
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Affiliation(s)
- Karen E MacKenzie
- Department of Diabetes and Endocrinology, Women's and Children's Hospital, Adelaide, South Australia, Australia.
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134
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Steinberger J, Daniels SR, Eckel RH, Hayman L, Lustig RH, McCrindle B, Mietus-Snyder ML. Progress and challenges in metabolic syndrome in children and adolescents: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular Nursing; and Council on Nutrition, Physical Activity, and Metabolism. Circulation 2009; 119:628-47. [PMID: 19139390 DOI: 10.1161/circulationaha.108.191394] [Citation(s) in RCA: 473] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Murasko JE. Male–female differences in the association between socioeconomic status and atherosclerotic risk in adolescents. Soc Sci Med 2008; 67:1889-97. [DOI: 10.1016/j.socscimed.2008.09.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2007] [Indexed: 10/21/2022]
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Affiliation(s)
- Jennifer Sacheck
- From the John Hancock Center for Physical Activity and Nutrition, Friedman School of Nutrition Science and Policy at Tufts University, Boston, Massachusetts
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137
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Abstract
There is a considerable debate about the potential influence of ‘fetal programming’ on cardiovascular diseases in adulthood. In the present prospective epidemiological cohort study, the relationship between birthweight and arterial elasticity in 472 children between 5 and 8 years of age was assessed. LAEI (large artery elasticity index), SAEI (small artery elasticity index) and BP (blood pressure) were assessed using the HDI/PulseWave™ CR-2000 CardioVascular Profiling System. Blood concentrations of glucose, total cholesterol and its fractions [LDL (low-density lipoprotein)-cholesterol and HDL (high-density lipoprotein)-cholesterol] and triacylglycerols (triglycerides) were determined by automated enzymatic methods. Insulin was assessed by a chemiluminescent method, insulin resistance by HOMA (homoeostasis model assessment) and CRP (C-reactive protein) by immunonephelometry. Two linear regression models were applied to investigate the relationship between the outcomes, LAEI and SAEI, and the following variables: birthweight, gestational age, glucose, LDL-cholesterol, HDL-cholesterol, triacylglycerols, insulin, CRP, HOMA, age, gender, waist circumference, per capita income, SBP (systolic BP) and DBP (diastolic BP). LAEI was positively associated with birthweight (P=0.036), waist circumference (P<0.001) and age (P<0.001), and negatively associated with CRP (P=0.024) and SBP (P<0.001). SAEI was positively associated with birthweight (P=0.04), waist circumference (P=0.001) and age (P<0.001), and negatively associated with DBP (P<0.001). Arterial elasticity was decreased in apparently healthy children who had lower birthweights, indicating an earlier atherogenetic susceptibility to cardiovascular diseases in adolescence and adult life. Possible explanations for the results include changes in angiogenesis during critical phases of intrauterine life caused by periods of fetal growth inhibition and local haemodynamic anomalies as a way of adaptation to abnormal pressure and flow.
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138
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Elevated CRP levels are associated with increased carotid atherosclerosis independent of visceral obesity. Atherosclerosis 2008; 200:417-23. [DOI: 10.1016/j.atherosclerosis.2007.12.050] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Revised: 11/18/2007] [Accepted: 12/21/2007] [Indexed: 11/19/2022]
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139
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Assessment of atherosclerotic cardiovascular risk and management of dyslipidemia in obese children. PROGRESS IN PEDIATRIC CARDIOLOGY 2008. [DOI: 10.1016/j.ppedcard.2008.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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140
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Abstract
OBJECTIVES To compare carotid intima-media thickness (cIMT) of children and adolescents with and without HIV infection and to determine associations among independent socio-demographic, clinical or cardiovascular variables and cIMT in HIV-infected children and adolescents. PATIENTS AND METHODS This is a matched case-control study comparing 83 HIV-infected and 83 healthy children and adolescents. Clinical and laboratorial parameters, cIMT and echocardiogram were measured. RESULTS The cIMT was higher in HIV-infected individuals (median 480 microm; interquartile range 463-518 microm) compared with controls (426 microm; range 415-453 microm, P<0.001). In addition, the HIV-infected group showed higher levels of high-sensitive C-reactive protein (medians 1.0 mg/l vs. 0.4 mg/l, P<0.001), glycated hemoglobin (6.1+/-0.9 vs. 5.7+/-0.8%, P=0.028) and triglycerides (medians 0.9 vs. 0.8 mmol/l, P=0.031). Finally, this group showed lower levels of total and high-density lipoprotein-cholesterol. After multivariate analysis, increased cIMT was positively associated with stavudine use [odds ratio (OR): 18.9, P=0.005], left atrial/aorta index (OR: 15.6, P=0.019), suprailiac skinfold (OR: 7.9, P=0.019), tachypnea (OR: 5.9, P=0.031), CD8 lymphocyte count (OR: 5.7, P=0.033) and CD4 T-lymphocyte count (OR: 5.5, P=0.025). cIMT increment was negatively associated with total cholesterol (OR: 0.2, P=0.025) and with CD8 zenith (OR: 0.1, P=0.007). CONCLUSION In this sample of children and adolescents, having HIV infection was associated with increased cIMT and elevated prevalence of cardiovascular risk factors. These findings suggest that this group should be included in cardiovascular prevention programs.
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141
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Ellins E, Halcox J, Donald A, Field B, Brydon L, Deanfield J, Steptoe A. Arterial stiffness and inflammatory response to psychophysiological stress. Brain Behav Immun 2008; 22:941-8. [PMID: 18316176 DOI: 10.1016/j.bbi.2008.01.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Revised: 01/03/2008] [Accepted: 01/21/2008] [Indexed: 11/27/2022] Open
Abstract
The processes through which psychological stress influences cardiovascular disease are poorly understood, but may involve activation of hemodynamic, neuroendocrine and inflammatory responses. We assessed the relationship between carotid arterial stiffness and inflammatory responses to acute psychophysiologic stress. Participants were 155 healthy men and women aged 55.3, SD 2.7 years. Blood samples for the assessment of plasma fibrinogen, tumor necrosis factor (TNF) alpha and interleukin (IL) 6 were drawn at baseline, immediately following standardized behavioral tasks, and 45 min later. Carotid artery stiffness was measured ultrasonically three years later, and blood pressure and heart rate responses were recorded. The tasks induced substantial increases in blood pressure and heart rate, together with increased fibrinogen, TNFalpha and IL-6 concentration. Carotid stiffness was positively associated with body mass, waist/hip ratio, blood pressure, low density lipoprotein cholesterol, and C-reactive protein, and inversely with high density lipoprotein and grade of employment. Baseline levels of inflammatory variables were not related to carotid artery stiffness. But carotid stiffness was greater in participants with larger fibrinogen (p=0.037) and TNFalpha (p=0.036) responses to psychophysiological stress. These effects were independent of age, gender, grade of employment, smoking, body mass, waist/hip ratio, systolic and diastolic pressure, high and low density lipoprotein cholesterol, and C-reactive protein. There were no associations between carotid stiffness and stress responses in IL-6, blood pressure, or heart rate. We conclude that individual differences in inflammatory responses to psychophysiological stress are independently related to structural changes in artery walls that reflect increased cardiovascular disease risk.
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Affiliation(s)
- Elizabeth Ellins
- Vascular Physiology Unit, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
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142
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Thomas NE, Williams DRR. Inflammatory factors, physical activity, and physical fitness in young people. Scand J Med Sci Sports 2008; 18:543-56. [DOI: 10.1111/j.1600-0838.2008.00824.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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143
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Shakouri P, Nezami N, Tarzamni MK, Rashid RJ. The elusive link between high sensitivity C-reactive protein and carotid subclinical atherosclerosis in coronary artery bypass grafting candidates: a cross-sectional study. Cardiovasc Ultrasound 2008; 6:23. [PMID: 18513415 PMCID: PMC2440732 DOI: 10.1186/1476-7120-6-23] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Accepted: 05/30/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies demonstrated a modest association between C-Reactive Protein (CRP), stenosis of carotid artery, and carotid Intima-Media Thickness (IMT) in general population. During present study, we aimed to evaluate the relationship between High Sensitivity C-Reactive Protein (hsCRP) and Common Carotid Intima-Media Thickness (CCIMT) in patients who candidate for Coronary Artery Bypass Grafting (CABG). METHODS The study subjects were enrolled from patients with coronary arteries disease referred from Shahid Madani Hospital (Tabriz, Iran), who have been candidate for elective CABG from January 2005 to August 2007. The common carotid arteries were evaluated with high-resolution B-mode ultrasonography using a 7.5- MHz linear-array transducer to determine the IMT and grade of stenosis. Serum hsCRP level was measured using commercially available enzyme linked immunosorbent assay kit. RESULTS Finally, information of 176 CABG candidates was analysed. The mean age of participants was 62.71 +/- 9.45 years with 1.63 male to female ratio. The mean of CCIMT was 0.69 +/- 0.54 mm. Although there was no significant correlation between serum hsCRP level and CCIMT in patients without carotid stenosis (p=0.113, r=0.186), participants with common carotid artery stenosis had higher levels of serum hsCRP than participants without stenosis (2.42+/-1.30 vs. 1.20+/-0.97 mg/dl; p=0.009). CONCLUSION Study results showed that there was no correlation between serum hsCRP level and CCIMT in patients without carotid stenosis, but patients with common carotid artery stenosis had higher levels of serum hsCRP than patients without stenosis.
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Affiliation(s)
- Parvin Shakouri
- Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran.
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144
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Amino-acid-based peritoneal dialysis solution improves amino-acid transport into skeletal muscle. Kidney Int 2008:S131-6. [PMID: 18379536 DOI: 10.1038/sj.ki.5002614] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Abnormalities of amino-acid (AA) and protein metabolism are known to occur in chronic kidney disease (CKD). Protein malnutrition may contribute to impaired prognosis of dialysis patients. A crucial step in protein metabolism is AA transport into the cells. We compared the effects of an AA-containing peritoneal dialysis (PD) solution to glucose-based solutions on skeletal muscle AA uptake. Thirteen nondiabetic PD patients were studied twice in a random order and in a crossover manner both in the fasting state and during euglycemic insulin stimulation using [(11)C]methylaminoisobutyrate ([(11)C]MeAIB) and positron emission tomography (PET). Before both PET study days, patients had been using either glucose-based PD solutions only or one daily bag of AA solution in addition to glucose-based PD solutions for at least 6 weeks. Skeletal muscle AA uptake was calculated with graphical analysis. AA-containing PD solution increased plasma AA concentrations from 2.18+/-0.34 to 3.08+/-0.55 mmol l(-1) in the fasting state (P=0.0002) and from 1.88+/-0.15 to 2.42+/-0.30 mmol l(-1) during insulin stimulation (P<0.0001). As compared to PD treatment using glucose-based solutions only, skeletal muscle AA uptake was significantly higher during treatment containing AA solution both in the fasting state (15.2+/-5.8 vs 20.0+/-5.6 micromol kg(-1) min(-1), respectively, P=0.0057) and during insulin stimulation (16.8+/-4.5 vs 21.1+/-4.9 micromol kg(-1) min(-1), respectively, P=0.0046). In conclusion, PD treatment with an AA-containing PD solution is associated with a significant increase in skeletal muscle AA uptake both in the fasting state and during insulin stimulation.
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145
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Gurven M, Kaplan H, Winking J, Finch C, Crimmins EM. Aging and inflammation in two epidemiological worlds. J Gerontol A Biol Sci Med Sci 2008; 63:196-9. [PMID: 18314457 DOI: 10.1093/gerona/63.2.196] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Humans evolved in a world with high levels of infection resulting in high mortality across the life span and few survivors to advanced ages. Under such conditions, a strong acute-phase inflammatory response was required for survival; however, inflammatory responses can also promote chronic diseases of aging. We hypothesize that global historical increases in life span at older ages are partly explained by reduced lifetime exposure to infection and subsequent inflammation. To begin a test of this hypothesis, we compare C-reactive protein (CRP); levels in two populations with different epidemiological environments: the Tsimane of Bolivia and persons in the United States. High CRP is significantly more prevalent among the Tsimane up through middle age; by age 35, the Tsimane have spent more years with high CRP than have Americans at age 55. Further testing of the links among infection, inflammation, and chronic diseases of aging among the Tsimane requires collection of age-specific indicators of atherosclerosis and cardiac function.
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Affiliation(s)
- Michael Gurven
- Department of Anthropology, University of California-Santa Barbara, USA
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146
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McCrindle BW, Manlhiot C. Elevated atherogenic lipoproteins in childhood: Risk, prevention, and treatment. J Clin Lipidol 2008; 2:138-46. [PMID: 21291732 DOI: 10.1016/j.jacl.2008.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Accepted: 04/09/2008] [Indexed: 11/16/2022]
Abstract
Elevated low-density lipoprotein cholesterol (LDL-C) level in childhood is an increasing problem, mainly due to a rising prevalence secondary to the childhood obesity epidemic and better recognition and screening. Vascular changes and impaired endothelial function associated with elevated LDL-C are apparent even in early childhood. Secondary adiposity-related cases are at higher risk due to the clustering of risk factors besides overweight, such as the atherogenic lipid triad, change in the atherogenic properties of the LDL-C particle itself, and the presence of insulin resistance. Prevention should focus on maintaining a healthy lifestyle, including a restricted fat and cholesterol diet, encouraging physical activity, and decreasing sedentary pursuits to maintain an appropriate weight in children. For children and adolescents found to have elevated LDL-C, management should focus on the pursuit of a healthy lifestyle mirroring that for prevention for at least 6 months. Additional dietary therapy, such as plant stanol and sterol esters, have also been shown to modestly reduce LDL-C levels. If the adoption of a healthy lifestyle is not sufficient to reduce LDL-C, lipid-lowering drugs should be considered in selected patients. Current drugs of choice are statins and potentially ezetimibe. Long-term treatment with statins has been shown to markedly reduce carotid intima-media thickness in children and adolescents, particularly when started early. Current evidence supports early and efficient treatment for affected children.
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Affiliation(s)
- Brian W McCrindle
- Division of Cardiology, Department of Pediatrics, University of Toronto, Labatt Family Heart Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8 Canada
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147
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Somberg TC, Arora RR. Depression and heart disease: therapeutic implications. Cardiology 2008; 111:75-81. [PMID: 18376116 DOI: 10.1159/000119692] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Accepted: 10/07/2007] [Indexed: 11/19/2022]
Abstract
The consequences of depression and coronary artery disease (CAD) were reviewed in the literature. The comorbidity of depression and CAD results in an increased cardiovascular mortality. We reviewed possible explanations for this increased morbidity, which include: toxicity of tricyclic antidepressants that can cause cardiac arrhythmias, abnormalities in platelet function leading to increased platelet aggregation due to abnormalities in serotonin in the platelet (an abnormality that possibly causes depression in the central nervous system), diffuse atherosclerosis causing central nervous system abnormalities including depression (vascular depression), as well as the possibility that depressed patients are less compliant with their medications and physician-directed health recommendations. Recent reports of selective serotonin reuptake inhibitors (SSRIs) causing a reduced cardiovascular mortality may be related to serotonin platelet abnormalities in depressed patients that are effectively treated by SSRIs (SADHART and ENRICHD trial). It is possible that these trials reveal a mechanism of depression that also effects platelet function and can be improved with SSRI therapy, suggesting a preferential therapeutic pathway for the treatment of depressed patients with CAD.
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148
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Gonzalez J, Wood JC, Dorey FJ, Wren TAL, Gilsanz V. Reproducibility of carotid intima-media thickness measurements in young adults. Radiology 2008; 247:465-71. [PMID: 18349312 DOI: 10.1148/radiol.2472070691] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively compare the reproducibility of carotid intima-media thickness (CIMT) measurements obtained from the right and left carotid arteries in young adults by using ultrasonographic (US) images acquired at the maximum dimension, minimum dimension, and electrocardiographically (ECG)-triggered cardiac end diastole. MATERIALS AND METHODS This study was HIPAA compliant and approved by the institutional review board; all participants provided informed consent. Medical history, anthropometric measurements, and blood pressure (BP) values were obtained from 50 men and 50 women aged 18-25 years. Images of the common carotid arteries were acquired from three independent complete cardiac cycles by using a 15L8-MHz US transducer. CIMT was measured on the images of each cycle that depicted the narrowest and widest vessel diameters, and at the R wave of the ECG. Measurements from the right and left carotid arteries were analyzed by using paired t tests; possible sex differences, by using unpaired t tests. Reproducibility was determined by using coefficients of variation and intraclass correlations (ICCs). Pearson correlations and multiple regression analyses were used to compare CIMT, body mass index (BMI), and BP. RESULTS CIMT values were 7.2% and 7% greater in frames showing the narrowest lumen diameter and in R-wave ECG-triggered frames, respectively, than in those with the widest diameter. CIMT measurements were 2.2%-3.1% greater in the right carotid artery than in the left (P < .001) and were significantly related to BMI (r = 0.40, P < .001) and systolic BP (r = 0.34, P < .001). ICCs were stronger when assessments were obtained in three different cardiac cycles (0.92-0.98), rather than in one (0.79-0.91). CONCLUSION In healthy young adults, reproducibility of CIMT measurements is greatest when combining values from both carotid arteries and/or from the maximal and minimal arterial diameters.
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Affiliation(s)
- Jaime Gonzalez
- Department of Radiology, Children's Hospital Los Angeles, MS No. 81, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
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Alizadeh Dehnavi R, Beishuizen ED, van de Ree MA, Le Cessie S, Huisman MV, Kluft C, Princen HMG, Tamsma JT. The impact of metabolic syndrome and CRP on vascular phenotype in type 2 diabetes mellitus. Eur J Intern Med 2008; 19:115-21. [PMID: 18249307 DOI: 10.1016/j.ejim.2007.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2006] [Revised: 04/20/2007] [Accepted: 06/12/2007] [Indexed: 11/15/2022]
Abstract
BACKGROUND The burden of cardiovascular disease in diabetes mellitus type 2 (DM2) patients is variable. We hypothesize that metabolic syndrome (MS) and low-grade systemic inflammation modify the extent of atherosclerosis in DM2. METHODS Vascular phenotype was determined using the following endothelium-related, hemostatic, and sonographic endpoints in 62 DM2 patients with mild dyslipidemia: sVCAM, sE-selectin, von Willebrand factor (VWF), fibrinogen, s-thrombomodulin (sTM), tPA, PAI-1, flow-mediated dilation (FMD), and intima media thickness (IMT). The impact of MS load (number of criteria present), MS components, and CRP on these parameters was assessed. RESULTS Serum sVCAM, sTM, and tPA levels significantly increased with increasing MS load. IMT also significantly increased from 0.602+/-0.034 (one MS criterion) to 0.843+/-0.145 (four MS criteria, p=0.007). LogCRP significantly correlated with fibrinogen, PAI-1, and IMT. In a multiple regression (MR) model with age and gender as covariates, MS load predicted sVCAM and sTM; CRP predicted PAI-1 and fibrinogen; MS load and CRP simultaneously predicted tPA and IMT. For each MS criterion present, IMT significantly increased by 0.04 mm. An increase in CRP from 1 to 3 mg/L resulted in a significant increase of 0.04 mm. Patients with four MS criteria and inflammation (CRP >or=3 mg/L) are predicted to have a 0.21 mm thicker IMT than those without. A second stepwise MR analysis based on gender, traditional risk factors, diabetes-related parameters, renal function, individual MS criteria, and LogCRP as explanatory variables showed a significant effect of systolic and diastolic blood pressure, HDL, and LogCRP on IMT(r(2)=0.36, p<0.001). CONCLUSION MS and low-grade chronic inflammation have an independent impact on vascular phenotype including IMT in DM2.
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Affiliation(s)
- Reza Alizadeh Dehnavi
- Vascular Medicine, Department of General Internal Medicine & Endocrinology, Leiden University Medical Centre, Leiden, The Netherlands.
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Abstract
PURPOSE OF REVIEW The prevalence of overweight and the metabolic syndrome is increasing in young people. This review aims to summarize current research in children and adolescents on inflammatory markers related to components of the metabolic syndrome. RECENT FINDINGS Obesity is characterized by a state of low-grade inflammation at all ages. Body fat has been shown to correlate with the various components of the metabolic syndrome. There is evidence to show that chronic subclinical inflammation in childhood and adolescence is associated with metabolic dysfunction, which can lead to insulin resistance and the metabolic syndrome. SUMMARY The results presented in this review highlight the underlying inflammatory mechanisms of the early stages of metabolic disorders related to obesity. The preclinical phases of diabetes and cardiovascular disease last many decades, and this feature of the diseases provides an opportunity for the early identification of target groups and the use of appropriate prevention strategies while the pathological processes are still completely reversible.
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Affiliation(s)
- Julia Wärnberg
- Immunonutrition Research Group, Department of Metabolism and Nutrition, Instituto del Frío, Spanish National Research Council (CSIC), Madrid, Spain.
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