Intima-Media Thickness Does Not Differ between Two Common Carotid Artery Segments in Children

Influence of Different Antiseizure Medications on Vascular Risk Factors in Children with Epilepsy

Many studies have proposed that plasma homocysteine levels are increased as a side effect with the prolonged use of antiseizure medications. This is associated with an increase in carotid intima media thickness; hence, it increases the threat of atherosclerosis at a young age. We aimed to assess serum levels of homocysteine in epileptic children on long-standing antiseizure medications and its association with increased occurrence of cardiovascular disease. The study included 60 epileptic children aged between 2 and 15 years old who visited our pediatric neurology outpatient clinic and 25 apparently healthy children served as a control group. All included children were subjected to careful history taking, clinical examination, anthropometric measures, laboratory investigations including serum homocysteine levels and lipid profile, along with radiological assessment involving carotid intima media thickness and carotid stiffness. Results demonstrated a significant increase in the serum levels of homocysteine, carotid intima media thickness, and carotid stiffness in children on monotherapy of old generation antiseizure medications and polytherapy than that in children on monotherapy of new generation antiseizure medications and control children. Epileptic children on old generation and polytherapy antiseizure medications have an increased risk for cardiovascular diseases and need follow up for early intervention when needed.

Current applications for measuring pediatric intima-media thickness

Intima-media thickness is a known subclinical radiologic marker of the early manifestations of atherosclerotic disease. It is the thickness of the vessel wall, most often the carotid artery. Intima-media thickness is measured on conventional US manually or automatically. Other measurement techniques include radiofrequency US. Because there is variation in its measurement, especially in children, several recommendations have been set to increase the measurement's validity and comparability among studies. Despite these recommendations, several pitfalls should be avoided, and quality control should be performed to avoid erroneous interpretation. This article summarizes current literature in relation to the clinical applications for intima-media thickness measurement in children with known risk factors such as obesity, liver steatosis, hypercholesterolemia, diabetes, hypertension, systemic inflammatory diseases, cancer survival, kidney and liver transplant, and sickle cell disease or beta thalassemia major. Most potential indications for intima-media thickness measurement remain in the research domain and should be interpreted combined with other markers. The objective of diagnosing an increased intima-media thickness is to start a multidisciplinary treatment approach to prevent disease progression and its sequelae in adulthood.

The Effect of Long-Term Atorvastatin Therapy on Carotid Intima-Media Thickness of Children With Dyslipidemia

Carotid intima-media thickness (cIMT) has been proposed as an early marker of subclinical atherosclerosis in high risk children. Children with heterozygous familial hypercholesterolemia have greater cIMT than matched healthy controls or their unaffected siblings. Statin therapy may delay the progression of cIMT, although long-term studies in children are scarce. We evaluated the effect of atorvastatin treatment on cIMT in children with dyslipidemia. We studied 81 children/adolescents, 27 with severe dyslipidemia (low-density lipoprotein cholesterol [LDL-C] ≥190 mg/dL) and 54 sex- and age-matched healthy controls; LDL-C ≤ 130 mg/dL and lipoprotein (a), Lp(a), ≤30 mg/dL. In the children with dyslipidemia, cIMT was measured twice, before and on treatment (18.2 ± 7.7 months). Anthropometric data, a full lipid profile, liver, kidney, and thyroid function were evaluated. Males with dyslipidemia had a greater cIMT than male controls after adjustment for other factors (P = .049). In addition, a nonstatistically significant decrease in cIMT was observed after treatment (P = .261). Treatment with atorvastatin resulted in a significantly improved lipid profile. Females with dyslipidemia had a significantly thinner cIMT than males. Children with normal and high Lp(a) levels had similar cIMT values. In conclusion, treatment with atorvastatin had a beneficial effect on the lipid profile and cIMT progression in children with severe dyslipidemia.

Vascular health determinants in children

BACKGROUND

The epidemic of cardiovascular disease (CVD) in the twentieth century generated numerous population-based surveys. These results clearly demonstrate that many factors are causally related to the development of atherosclerosis. Eighty percent of the CVD can be explained by smoking, high blood pressure, deterioration of lipid and glucose metabolism and physical inactivity. CVD is a disease that becomes clinically apparent in adults. However, it is undisputed that this disease develops over a long period of time due to progressive, subclinical changes in the cardiovascular system. The early manifestation of arteriosclerosis correlates with traditional risk factors.

METHODS

This brief report focusses on determinates of vascular health. It describes non-invasive diagnostic methods such as oscillometric analysis of pulse wave velocity (PWV), ultrasound measurement of carotid structure and function as well as brachial endothelial function. Special attention is paid to possible correlations with physical activity, fitness and exercise.

RESULTS

Non-invasive diagnostic methods to determine vascular health are applicable in children. The influence of physical activity and the relationship between aerobic fitness and arterial compliance (AC) remain controversial. First results in young athletes demonstrated an increased carotid intima-media thickness (cIMT), by revealing arterial elasticity. The mechanism and determinants explaining these adaptations have not been fully explained in young healthy athletes.

CONCLUSIONS

Traditional cardiovascular risk factors act early in life and have a major impact on the development of atherosclerosis. The results underline that the prevention strategies and risk factor control should begin in childhood. The emphasis in the present report lied on the determination of vascular health, analyzing arterial structure and function, using non-invasive diagnostic methods. Vascular health and its relation to obesity, hypertension, physical activity and exercise were emphasized. The harmonization of knowledge and methods would greatly increase the comparability of existing results. To further elucidate the clinical relevance, the mechanisms linking arterial structure and compliance function with physical activity, fitness and exercise need further clinical investigation to enhance early preventive intervention strategies.