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Henderson AM, Islam N, Sandor GGS, Panagiotopoulos C, Devlin AM. Greater Arterial Stiffness in Children with or without Second-generation Antipsychotic Treatment for Mental Health Disorders: Rigidité Artérielle Plus Importante Chez Les Enfants Avec ou Sans Traitement Par Antipsychotiques de la Deuxième Génération Pour des Troubles de Santé Mentale. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:667-676. [PMID: 34180273 PMCID: PMC8243168 DOI: 10.1177/0706743720974838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Second-generation antipsychotics (SGAs) are used for a variety of mental disorders and are associated with cardiometabolic side effects in children. The objective of this study was to assess the cardiovascular health of children with mental disorders that are SGA-treated or SGA-naive. METHODS SGA-treated (n = 47) or SGA-naive (n = 37) children (aged 6 to 18 years) with mental disorders and control children (n = 83, no mental disorder) underwent assessment for cardiac function and morphology by echocardiography, aortic pulse wave velocity (PWV), and carotid intima-media thickness (cIMT). Body mass index (BMI) z-scores, waist circumference z-scores, systolic and diastolic blood pressure (BP) percentiles for height and sex, and fasting plasma glucose, insulin, triglycerides, and cholesterol were also assessed. Differences between SGA-treated, SGA-naive, and control children were assessed by linear and log-linear regression models. RESULTS SGA-treated children had greater BMI z-scores and overweight/obesity (BMI ≥ 85th percentile for age and sex) and hypertension than SGA-naive and control children. The PWV geometric mean was 11.1% higher in SGA-treated (95%CI, 3.95 to 18.77) and 12.9% higher in SGA-naive children (95% CI, 5.60 to 20.59) compared to controls in models adjusted for age, sex, BMI, and systolic BP percentile. Left ventricular (LV) end-diastolic dimension/body surface area (BSA), LV end-systolic dimension/BSA, and LV ejection fraction were lower in SGA-treated and SGA-naive children compared to controls in models adjusted for sex and age. CONCLUSIONS Children with mental disorders have greater arterial stiffness and altered cardiac structure/function than children with no mental health diagnosis. SGA treatment in children is not associated with alterations in cardiovascular structure/function.
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Affiliation(s)
- Amanda M Henderson
- Department of Pediatrics, BC Children's Hospital Research Institute, 8166The University of British Columbia, Vancouver, British Columbia, Canada
| | - Nazrul Islam
- MRC Epidemiology Unit, University of Cambridge, United Kingdom
| | - George G S Sandor
- Department of Pediatrics, BC Children's Hospital Research Institute, 8166The University of British Columbia, Vancouver, British Columbia, Canada
| | - Constadina Panagiotopoulos
- Department of Pediatrics, BC Children's Hospital Research Institute, 8166The University of British Columbia, Vancouver, British Columbia, Canada
| | - Angela M Devlin
- Department of Pediatrics, BC Children's Hospital Research Institute, 8166The University of British Columbia, Vancouver, British Columbia, Canada
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TİMURTAŞ E, ÇINAR E, KARABACAK N, DEMİRBÜKEN İ, POLAT MG. ASSOCIATION OF PHYSICAL FITNESS INDICATORS WITH HEALTH PROFILE AND LIFESTYLE OF CHILDREN. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.776067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Torigoe T, Dallaire F, Slorach C, Cardinal MP, Hui W, Bradley TJ, Sarkola T, Mertens L, Jaeggi E. New Comprehensive Reference Values for Arterial Vascular Parameters in Children. J Am Soc Echocardiogr 2020; 33:1014-1022.e4. [DOI: 10.1016/j.echo.2020.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 01/28/2020] [Accepted: 03/01/2020] [Indexed: 11/15/2022]
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Corica D, Oreto L, Pepe G, Calabrò MP, Longobardo L, Morabito L, Pajno GB, Alibrandi A, Aversa T, Wasniewska M. Precocious Preclinical Cardiovascular Sonographic Markers in Metabolically Healthy and Unhealthy Childhood Obesity. Front Endocrinol (Lausanne) 2020; 11:56. [PMID: 32194501 PMCID: PMC7062712 DOI: 10.3389/fendo.2020.00056] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/29/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Childhood obesity is related to a wide spectrum of cardiovascular and metabolic comorbidities. Objectives: (1) To identify precocious, preclinical, cardiovascular sonographic modifications, in a cohort of overweight (OW) and obese (OB) children and adolescents compared to lean controls; (2) to investigate the association between clinical and metabolic variables and cardiovascular sonographic parameters; (3) to evaluate their relation with two different phenotypes of obesity: metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO). Materials and Methods: Fifty-nine OW and OB children and adolescents (9.8 ± 2.9 years) and 20 matched lean controls underwent anthropometric, biochemical, echocardiography assessment, and sonographic evaluation of carotid artery and ascending aorta (AA). OW and OB subjects were divided in MHO and MUO, according to the Camhi et al. definition. Results: OW and OB children showed significantly higher left ventricular (LV) dimensions and mass, carotid artery intima-media thickness (CIMT), carotid stiffness [β-index, pulse wave velocity (PWV)], significantly lower mitral peak early (E) and late (A) velocity ratio (E/A ratio), and significantly impaired global longitudinal strain (GLS) compared to controls. BMI SD and HOMA-IR were positively significantly related to LV dimensions, LA volume and epicardial adipose tissue (EAT), and negative to E/A ratio. Waist circumference (WC) was positively correlated to LV dimensions, LA volume, CIMT, PWV, AA diameter, and EAT. Furthermore, WC was a strong predictor of LV dimensions, LA volume and strain, AA stiffness and diameter; BMI SD was significantly associated with EAT, LVM index, and E/A ratio; HOMA-IR and triglycerides were significant predictors of GLS. MUO patients showed higher BMI SD (p = 0.02), WC (p = 0.001), WHtR (p = 0.001), HOMA-IR (p = 0.004), triglycerides (p = 0.01), SBP (p = 0.001), as well as LV dimensions, EAT (p = 0.03), CIMT (p = 0.01), AA diameter (p = 0.02), β-index (p = 0.03) and PWV (p = 0.002), AA stiffness (p = 0.006), and significantly impaired GLS (p = 0.042) compared to MHO. Conclusions: Severity of overweight, abdominal obesity, insulin resistance, and MUO phenotype negatively affect cardiovascular remodeling and subclinical myocardial dysfunction in OW and OB children. MUO phenotype is likely to increase the risk of developing cardiometabolic complications since the pediatric age. Distinction between MHO and MUO phenotypes might be useful in planning a personalized follow-up approach in obese children.
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Affiliation(s)
- Domenico Corica
- Department of Human Pathology of Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
- *Correspondence: Domenico Corica
| | - Lilia Oreto
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giorgia Pepe
- Department of Human Pathology of Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | - Maria Pia Calabrò
- Department of Human Pathology of Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | - Luca Longobardo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Letteria Morabito
- Department of Human Pathology of Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | - Giovanni Battista Pajno
- Department of Human Pathology of Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | | | - Tommaso Aversa
- Department of Human Pathology of Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology of Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
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Jakab AE, Hidvégi EV, Illyés M, Cziráki A, Kalmár T, Maróti Z, Bereczki C. Childhood Obesity: Does it Have Any Effect on Young Arteries? Front Pediatr 2020; 8:389. [PMID: 32766188 PMCID: PMC7378393 DOI: 10.3389/fped.2020.00389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 06/08/2020] [Indexed: 01/13/2023] Open
Abstract
Prevalence of overweight (OW) and obesity (O) in children and adolescents has been increased in the past three decades. Increased arterial stiffness measuring by aortic pulse wave velocity (PWVao) might be detected in OW/O children and adolescents. The aim of our study was to compare the arterial function parameters (AFPs), such as PWVao; aortic augmentation index (Aixao); aortic systolic blood pressure (SBPao) and brachial systolic blood pressure (SBPbrach) measured simultaneously in O/OW patients and healthy subjects. In our study 6,816 subjects (3,668 boys) aged 3-18 years were recruited and categorized by their body mass index (BMI) into normal weight (N), OW and O groups regarding their age and sex. AFPs were measured by a non-invasive, occlusive-oscillometric device. 19.9% (n = 1,356) of the population were OW/O, 911 (516 boys) were OW and 445 (272 boys) were O. After accounting for the effect of covariates, PWVao did not differ significantly between N (5.9 ± 0.8 m/s) and OW patients (5.9 ± 0.8 m/s); and N (6.0 ± 0.7 m/s) and O patients (6.0 ± 0.8 m/s). Aixao was significantly lower in OW (9.3 ± 7.4% vs. 7.6 ± 7.0%, p < 0.00001) and in O patients (9.7 ± 8.1% vs. 6.6 ± 7.2%, p < 0.00001) compared to controls. No significant difference was found regarding SBPao values between controls and OW and O groups (N = 110.7 ± 12.4 mmHg vs. OW = 110.3 ± 11.9 mmHg; N = 115.6 ± 14.0 mmHg vs. O = 114.3 ± 12.8 mmHg). According to our results we may conclude that the unchanged PWVao in O/OW subjects might be due to the compensatory decrease in Aixao, referring to enhanced vasodilatory status in the studied population.
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Affiliation(s)
- Andrea Emese Jakab
- Department of Pediatrics, Albert Szent-Györgyi Health Center, University of Szeged, Szeged, Hungary
| | | | - Miklós Illyés
- Heart Institute, UP Clinical Centre, University of Pécs, Pécs, Hungary
| | - Attila Cziráki
- Heart Institute, UP Clinical Centre, University of Pécs, Pécs, Hungary
| | - Tibor Kalmár
- Department of Pediatrics, Albert Szent-Györgyi Health Center, University of Szeged, Szeged, Hungary
| | - Zoltán Maróti
- Department of Pediatrics, Albert Szent-Györgyi Health Center, University of Szeged, Szeged, Hungary
| | - Csaba Bereczki
- Department of Pediatrics, Albert Szent-Györgyi Health Center, University of Szeged, Szeged, Hungary
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Bonafini S, Giontella A, Tagetti A, Montagnana M, Benati M, Danese E, Minuz P, Maffeis C, Antoniazzi F, Fava C. Markers of subclinical vascular damages associate with indices of adiposity and blood pressure in obese children. Hypertens Res 2019; 42:400-410. [DOI: 10.1038/s41440-018-0173-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 09/09/2018] [Accepted: 09/11/2018] [Indexed: 01/01/2023]
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Escudero CA, Potts JE, Lam PY, De Souza AM, Mugford GJ, Sandor GGS. Doppler Echocardiography Assessment of Aortic Stiffness in Female Adolescents with Anorexia Nervosa. J Am Soc Echocardiogr 2018; 31:784-790. [PMID: 29559196 DOI: 10.1016/j.echo.2018.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Anorexia nervosa (AN) is associated with abnormalities in biomarkers of cardiovascular risk. Arterial stiffness, as measured by pulse-wave velocity (PWV), is also a risk factor for cardiovascular disease. The aims of this study were to determine the stiffness of the aorta in female adolescents with AN and to determine if either the severity or the type of AN was associated with PWV. METHODS This was a retrospective case-control study. Adolescent patients with a clinical diagnosis of AN were included. Aortic diameter and pulse-wave transit time over a portion of the thoracic aorta were measured using Doppler echocardiography, and PWV was calculated. RESULTS There were 94 female patients with AN and 60 adolescent female control subjects. There was no significant difference in age between patients with AN and control subjects (15.5 ± 1.7 vs 15.1 ± 2.6 years, P = .220). Body mass index (16.0 ± 2.4 vs 19.7 ± 2.7 kg/m2, P < .001) and body mass index percentile (9.4 ± 15.6 vs 45.5 ± 26.2, P < .001) were significantly lower for patients with AN than control subjects. PWV (443 ± 106 vs 383 ± 77 cm/sec, P < .001) was significantly higher in patients with AN than control subjects. Similar differences from control subjects were found in patients with AN with both lower and higher body mass index percentiles and also in patients with AN with the restrictive or the binge-purge subtype. CONCLUSIONS Female adolescents with AN have increased aortic stiffness compared with control subjects. This study suggests that patients with AN may be at increased risk for future cardiovascular disease. Future studies are required to determine the reversibility of these changes with weight restoration.
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Affiliation(s)
- Carolina A Escudero
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - James E Potts
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Pei-Yoong Lam
- Division of Adolescent Medicine, British Columbia Children's Hospital and Provincial Specialized Eating Disorders Program, Vancouver, British Columbia, Canada
| | - Astrid M De Souza
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Gerald J Mugford
- Memorial University of Newfoundland, Faculty of Medicine and Discipline of Psychiatry, St. John's, Newfoundland, Canada
| | - George G S Sandor
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
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Floriańczyk T, Gołąbek-Dylewska M, Kucińska B, Werner B. Evaluation of left ventricular function in overweight children and teenagers with arterial hypertension and white coat hypertension. Cardiol J 2017; 26:343-349. [PMID: 29240959 DOI: 10.5603/cj.a2017.0151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 12/14/2017] [Accepted: 11/08/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Obesity in childhood is strongly associated with elevated arterial blood pressure and risk of hypertension. The aim of the study was the evaluation of left ventricular (LV) function in hypertensive and white coat hypertensive overweight children and teenagers. METHODS The study group consisted of 74 overweight patients aged 10.3 ± 3.1 years (range: 6-16 years) diagnosed as hypertensive in standard blood pressure measurement. The control group consisted of 31 normotensive and normoweight children. Ambulatory blood pressure monitoring (ABPM) and echocardiographic assessment of the LV mass and function were performed in all participants. RESULTS Using ABPM hypertension was confirmed in 20 (27%) children. In the 54 (73%) remaining children white coat hypertension was diagnosed. The analysis of echocardiographic parameters revealed higher LV mass index (LVMI) in hypertensive overweight than in normotensive normoweight children (47.5 ± 9.2 g/m2.7 vs. 39.8 ± 12.1 g/m2.7; p < 0.05) and no difference between overweight hypertensive and white coat hypertension-hypertensive groups. The deceleration time of mitral early filling (DCT) was longer in hypertensive normoweight children than in normotensive overweight patients (219.5 ± 110.3 ms vs. 197.8 ± 65.8 ms; p < 0.05). A significant correlation between systolic blood pressure load (SBPL) and DCT (r = 0.57) and moderate correlation between SBPL and LVMI (r: 0.48) as well as between LVMI and isovolumetric relaxation time (r = 0.37) were found. CONCLUSIONS In overweight children the diagnosis of hypertension should be confirmed in ABPM because of the high prevalence of white coat hypertension. Periodic echocardiographic examinations should be recommended in overweight children with increased SBPL and decreased systolic nocturnal deep because of the possibility of LV function impairment.
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Affiliation(s)
- Tomasz Floriańczyk
- Department of Pediatric Cardiology and General Pediatrics. Medical University of Warsaw, Poland
| | | | - Beata Kucińska
- Department of Pediatric Cardiology and General Pediatrics. Medical University of Warsaw, Poland
| | - Bożena Werner
- Department of Pediatric Cardiology and General Pediatrics. Medical University of Warsaw, Poland.
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Ye C, Pan Y, Xu X, Su S, Snieder H, Treiber F, Kapuku G, Wang X. Pulse wave velocity in elastic and muscular arteries: tracking stability and association with anthropometric and hemodynamic measurements. Hypertens Res 2016; 39:786-791. [PMID: 27334066 DOI: 10.1038/hr.2016.67] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/27/2016] [Accepted: 05/05/2016] [Indexed: 01/26/2023]
Abstract
Pulse wave velocity (PWV) has been used as a measurement for arterial stiffness, a predictor of cardiovascular risk. Tracking describes the stability of a measurement over time. The purpose of this study was to evaluate the tracking stability of carotid-femoral (cfPWV), carotid-radial (crPWV) and carotid-distal (cdPWV) PWV in young adults and their associations with anthropometric and hemodynamic measurements. cfPWV, crPWV and cdPWV were measured by tonometric (SphygmoCor) technique in 531 subjects (aged 23.7±4.9 with 42.9% African Americans and 49.9% females). Out of these subjects, 142 subjects had all these 3 PWV measurements evaluated again during their next visit with an average follow-up time of 2 years. In the tracking analysis on the data from the 142 subjects, cfPWV displayed moderate to relatively high tracking ability (r=0.61, P<0.001), whereas crPWV and cdPWV only displayed low to moderate tracking coefficients (r=0.29 and r=0.36 respectively, P<0.001). In the association test on the data from the 531 subjects, all three PWV measurements showed significant correlations with age and obesity related measurements. cfPWV displayed stronger correlations with these parameters. In addition, all three PWVs showed significant correlations with systolic blood pressure, diastolic blood pressure, mean arterial pressure and pulse pressure with the exception that no correlation existed between crPWV and pulse pressure. The higher tracking ability of cfPWV and its higher association with obesity related measurements highlights the importance of using cfPWV compared with crPWV and cdPWV for research and clinical settings.
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Affiliation(s)
- Chengcheng Ye
- Medical College of Georgia, Georgia Regents University, Augusta, GA, USA
| | - Yue Pan
- Department of Pediatrics, Georgia Prevention Institute, Medical College of Georgia, Georgia Regents University, Augusta, GA, USA
| | - Xiaojing Xu
- Department of Pediatrics, Georgia Prevention Institute, Medical College of Georgia, Georgia Regents University, Augusta, GA, USA
| | - Shaoyong Su
- Department of Pediatrics, Georgia Prevention Institute, Medical College of Georgia, Georgia Regents University, Augusta, GA, USA
| | - Harold Snieder
- Department of Pediatrics, Georgia Prevention Institute, Medical College of Georgia, Georgia Regents University, Augusta, GA, USA.,Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Frank Treiber
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Gaston Kapuku
- Department of Pediatrics, Georgia Prevention Institute, Medical College of Georgia, Georgia Regents University, Augusta, GA, USA
| | - Xiaoling Wang
- Department of Pediatrics, Georgia Prevention Institute, Medical College of Georgia, Georgia Regents University, Augusta, GA, USA
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Philip R, Alpert BS, Schwingshackl A, Huang X, Blakely D, Rovnaghi CR, Tran QT, Velasquez A, Arevalo A, Anand KJS. Inverse Relationship between Cardio-Ankle Vascular Index and Body Mass Index in Healthy Children. J Pediatr 2015; 167:361-365.e1. [PMID: 26003881 DOI: 10.1016/j.jpeds.2015.04.042] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 03/06/2015] [Accepted: 04/15/2015] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To establish reference scores for cardio-ankle vascular index (CAVI), a noninvasive measure of vascular function, which reflects the stiffness of arteries, in healthy children, to test for racial and ethnic differences, and to compare CAVI scores between overweight and normal weight children. STUDY DESIGN Subjects included 292 children aged 10-18 years: 100 non-Hispanic whites, 89 non-Hispanic blacks, and 103 Hispanics. Subjects were grouped as normal weight (body mass index [BMI] <85th percentile for age) and overweight (BMI >85th percentile for age). Blood pressure (BP) and CAVI scores were measured in all subjects. RESULTS After controlling for age, sex, and BMI, normal weight black males had a higher CAVI score (indicating stiffer arteries) in comparison with Hispanic males and white males (5.53 ± 0.15 vs 5.13 ± 0.15 vs 5.02 ± 0.15, P = .04). BMI had an inverse association on the CAVI score (r = -0.335, P < .0001). In multivariable analysis, BMI and average CAVI scores were significant predictors of each other (R(2) = 0.37, P < .0001, R(2) = 0.21, P < .0001). There was no significant correlation between CAVI scores and resting BP values, confirming that CAVI scores were independent of concurrent BP values. CONCLUSIONS Significant differences in vascular function exist among ethnic groups of children. Overweight children had lower CAVI scores, suggestive of vascular adaptation to obesity in early life. CAVI, by providing a noninvasive measure of vascular health, may help identify children at increased risk for cardiovascular disease.
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Affiliation(s)
- Ranjit Philip
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN.
| | - Bruce S Alpert
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Andreas Schwingshackl
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Xin Huang
- University of Tennessee, Knoxville, TN
| | | | - Cynthia R Rovnaghi
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Quynh T Tran
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | | | - Alejandro Arevalo
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Kanwaljeet J S Anand
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
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Hudson LD, Rapala A, Khan T, Williams B, Viner RM. Evidence for contemporary arterial stiffening in obese children and adolescents using pulse wave velocity: A systematic review and meta-analysis. Atherosclerosis 2015; 241:376-86. [PMID: 26071661 DOI: 10.1016/j.atherosclerosis.2015.05.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 05/07/2015] [Accepted: 05/08/2015] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Pulse wave velocity (PWV) and augmentation index (AI) may provide information on future cardiovascular risk. Reports are conflicting on whether obese children show evidence of raised PWV and AI. METHODS Systematic review and meta-analysis of published studies using EMBASE, Web-of-Science and PUBMED databases for studies reporting PWV and AI in obese versus non-obese controls(<age 18 years). Studies were pooled in meta-analyses to generate weighted mean differences (WMD) using random effects methodology. Analyses were repeated by method, quality grade and anatomical region. RESULTS 383 studies were found in initial searches and 81 were assessed in detail; 14 studies (6677 total participants, 1120 obese and 5557 non-obese) were suitable for meta-analysis for PWV, and 5 studies (728 participants obese and 317 non-obese) for AI. Across all studies, obese children had higher PWV than non-obese children (WMD 0.45(95% confidence interval 0.10 to 0.81 ms(-)(1))). This difference was not significant when only studies with low/medium risk of bias were included. Obese subjects had higher PWV measured directly at the carotid (WMD 0.51 (0.35-0.67 ms(-)(1))) and aorta (WMD 1.33 (0.36-2.31)). No significant differences were found for AI. Heterogeneity was high in all analyses(I(2) > 90% in PWV and AI meta-analyses). CONCLUSION There is moderate evidence that obese children have increased arterial stiffening, especially in central arteries. This supports concerns about future CVD risk in obese children. Developing effective obesity interventions must remain a health priority.
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Affiliation(s)
- Lee D Hudson
- UCL Institute of Child Health, London, United Kingdom.
| | - Alicja Rapala
- Vascular Physiology Unit, University College London, United Kingdom
| | - Tauseef Khan
- Vascular Physiology Unit, University College London, United Kingdom
| | - Bryan Williams
- Vascular Physiology Unit, University College London, United Kingdom
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Cote AT, Phillips AA, Harris KC, Sandor GG, Panagiotopoulos C, Devlin AM. Obesity and Arterial Stiffness in Children. Arterioscler Thromb Vasc Biol 2015; 35:1038-44. [DOI: 10.1161/atvbaha.114.305062] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective—
Childhood obesity is associated with risk factors for cardiovascular disease. Arterial stiffness is considered one of the earliest detectable measures of vascular damage. There is controversy in the literature regarding the effects of childhood obesity on arterial stiffness. The objective of this study is to systematically review the literature and to conduct a meta-analysis comparing measures of central arterial stiffness in children and adolescents with obesity to healthy body mass index controls.
Approach and Results—
Literature searches were conducted using databases (eg, MEDLINE, EMBASE) and citations cross-referenced. Studies assessing central pulse wave velocity or β-stiffness index were included. A random effects meta-analysis of the standardized mean difference and 95% confidence intervals in arterial stiffness between children with obesity and control children was performed for each arterial stiffness measure. A total of 523 studies were identified. Fifteen case–control studies were included, with 2237 children/adolescents (1281 with obesity, 956 healthy body mass index controls) between 5 and 24 years of age. All studies measuring carotid and aortic β-stiffness index and 10/12 studies measuring central pulse wave velocity reported greater arterial stiffness in children/adolescents with obesity compared with controls. A random effects meta-analysis was performed revealing a significant effect of obesity on pulse wave velocity (standardized mean difference=0.718; 95% confidence interval=0.291–1.415), carotid β-stiffness index (0.862; 0.323–1.402), and aortic β stiffness index (1.017; 0.419–1.615).
Conclusion—
These findings indicate that child/adolescent obesity is associated with greater arterial stiffness. However, further research is needed to address confounders, such as pubertal status, that may affect this relationship in children. In the future, these techniques may be useful in risk stratification and guiding clinical management of obese children to optimize cardiovascular outcomes.
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Affiliation(s)
- Anita T. Cote
- From the Department of Pediatrics, University of British Columbia, and Child & Family Research Institute, Vancouver, Canada (A.T.C., K.C.H., G.G.S.S., C.P., A.M.D.); and Centre for Heart, Lung, and Vascular Health, Faculty of Health and Social Development, University of British Columbia, Kelowna, Canada (A.A.P.)
| | - Aaron A. Phillips
- From the Department of Pediatrics, University of British Columbia, and Child & Family Research Institute, Vancouver, Canada (A.T.C., K.C.H., G.G.S.S., C.P., A.M.D.); and Centre for Heart, Lung, and Vascular Health, Faculty of Health and Social Development, University of British Columbia, Kelowna, Canada (A.A.P.)
| | - Kevin C. Harris
- From the Department of Pediatrics, University of British Columbia, and Child & Family Research Institute, Vancouver, Canada (A.T.C., K.C.H., G.G.S.S., C.P., A.M.D.); and Centre for Heart, Lung, and Vascular Health, Faculty of Health and Social Development, University of British Columbia, Kelowna, Canada (A.A.P.)
| | - George G.S. Sandor
- From the Department of Pediatrics, University of British Columbia, and Child & Family Research Institute, Vancouver, Canada (A.T.C., K.C.H., G.G.S.S., C.P., A.M.D.); and Centre for Heart, Lung, and Vascular Health, Faculty of Health and Social Development, University of British Columbia, Kelowna, Canada (A.A.P.)
| | - Constadina Panagiotopoulos
- From the Department of Pediatrics, University of British Columbia, and Child & Family Research Institute, Vancouver, Canada (A.T.C., K.C.H., G.G.S.S., C.P., A.M.D.); and Centre for Heart, Lung, and Vascular Health, Faculty of Health and Social Development, University of British Columbia, Kelowna, Canada (A.A.P.)
| | - Angela M. Devlin
- From the Department of Pediatrics, University of British Columbia, and Child & Family Research Institute, Vancouver, Canada (A.T.C., K.C.H., G.G.S.S., C.P., A.M.D.); and Centre for Heart, Lung, and Vascular Health, Faculty of Health and Social Development, University of British Columbia, Kelowna, Canada (A.A.P.)
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Childhood Obesity, Arterial Stiffness, and Prevalence and Treatment of Hypertension. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:339. [DOI: 10.1007/s11936-014-0339-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Koopman LP, Mertens LL. Impact of Childhood Obesity on Cardiac Structure and Function. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:345. [DOI: 10.1007/s11936-014-0345-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Miyoshi H, Oishi Y, Mizuguchi Y, Iuchi A, Nagase N, Ara N, Oki T. Contribution of obesity to left atrial and left ventricular dysfunction in asymptomatic patients with hypertension: A two-dimensional speckle-tracking echocardiographic study. ACTA ACUST UNITED AC 2013; 8:54-63. [PMID: 24131668 DOI: 10.1016/j.jash.2013.08.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 08/20/2013] [Accepted: 08/23/2013] [Indexed: 10/26/2022]
Abstract
Hypertension and obesity each are well known to result in heart failure with preserved ejection fraction. Therefore, it is clinically important to clarify the mechanisms of further deterioration of left atrial (LA)-left ventricular (LV) interaction in asymptomatic patients with obesity in the presence of hypertension. Data on conventional and two-dimensional speckle-tracking echocardiography (2DSTE) were obtained from 134 asymptomatic hypertensive patients. The study sample was divided into two groups: non-obese (n = 80; body mass index [BMI] <25 kg/m(2)] and obese (n = 54; BMI ≥25 kg/m(2)). The end-diastolic LV diameter, ratio of early transmitral flow to mitral annular motion velocity (E/e'), peak systolic LV circumferential strain rate, and E/e'/peak systolic LA strain (S-LAs) were greater in the obese group. Among the significantly correlated variables with BMI and E/e'/S-LAs in univariate analyses, multivariate analyses revealed that BMI is independently associated with end-diastolic LV diameter and peak systolic LV radial strain in all hypertensive patients, and that age, systolic blood pressure, relative LV wall thickness, peak systolic mitral annular motion velocity (s'), peak systolic LV radial strain, and peak early diastolic LV longitudinal strain rate are identified as independent predictors related to E/e'/S-LAs in the obese patients, whereas only s' contributes to the E/e'/S-LAs in the non-obese patients. Impaired LA-LV interaction was accelerated with obesity in the presence of hypertension. Assessment of the LA and LV function using 2DSTE provided additional information to the negative effects of cardiovascular risk factors on the LA and LV function in patients without clinical symptoms.
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Affiliation(s)
- Hirokazu Miyoshi
- Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization, Tokushima, Japan.
| | - Yoshifumi Oishi
- Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization, Tokushima, Japan
| | - Yukio Mizuguchi
- Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization, Tokushima, Japan
| | - Arata Iuchi
- Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization, Tokushima, Japan
| | - Norio Nagase
- Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization, Tokushima, Japan
| | - Nusrat Ara
- Department of Cardiology, Rawalpindi Medical College, Rawalpindi, Pakistan
| | - Takashi Oki
- Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization, Tokushima, Japan
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16
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Cote AT, Harris KC, Panagiotopoulos C, Sandor GGS, Devlin AM. Childhood obesity and cardiovascular dysfunction. J Am Coll Cardiol 2013; 62:1309-19. [PMID: 23954339 DOI: 10.1016/j.jacc.2013.07.042] [Citation(s) in RCA: 311] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 07/19/2013] [Accepted: 07/22/2013] [Indexed: 12/17/2022]
Abstract
Obesity-related cardiovascular disease in children is becoming more prevalent in conjunction with the rise in childhood obesity. Children with obesity are predisposed to an increased risk of cardiovascular morbidity and mortality in adulthood. Importantly, research in children with obesity over the last decade has demonstrated that children may exhibit early signs of cardiovascular dysfunction as a result of their excess adiposity, often independent of other obesity-related comorbidities such as dyslipidemia and insulin resistance. The clinical evidence is accumulating to suggest that the cardiovascular damage, once observed only in adults, is also occurring in obese children. The objective of this review is to provide a synopsis of the current research on cardiovascular abnormalities in children with obesity and highlight the importance and need for early detection and prevention programs to mitigate this potentially serious health problem.
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Affiliation(s)
- Anita T Cote
- Department of Pediatrics, University of British Columbia, Child and Family Research Institute, Vancouver, British Columbia, Canada
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