Assessment of traditional and non-traditional risk factors for premature atherosclerosis in children with juvenile dermatomyositis and pediatric controls

Dawn M Wahezi,Jaeun Choi,Marija Dionizovik-Dimanovski,Jillian Parekh,Emily J Liebling,Qi Gao

doi:10.1186/s12969-020-0415-5

Abstract

BackgroundChildren with juvenile dermatomyositis (JDM), the most common inflammatory myopathy of childhood, may be at increased risk of premature atherosclerosis given a host of traditional and non-traditional risk factors. The primary aim of this study was to determine the underlying frequency of premature atherosclerosis in children with JDM compared to pediatric controls using flow-mediated dilation as a measure of endothelial function.MethodsChildren and adolescents with and without JDM were evaluated for traditional atherosclerotic risk factors and assessment of endothelial function, using Endothelial Pulse Amplitude Testing (Endo-PAT).ResultsIn this study, 75% of pediatric controls were of Black or Hispanic descent (compared to 55% in the JDM group) and 70% were found to live in a household with a medium income less than $50,000/year (compared to 45% in the JDM group). Among traditional atherogenic risk factors, lipoprotein A appeared to be different between controls and JDM patients (66 nmol/L and 16.5 nmol/L, respectively). Using a reactive hyperemia index (RHI) < 1.67 as evidence of endothelial dysfunction, 75% of controls were defined as having endothelial dysfunction compared to 50% in JDM group. When controlled for lipoprotein A as an atherogenic confounder, JDM patients were found to have a 41% increase in RHI, thus indicating less endothelial dysfunction compared to controls.ConclusionsIn this study, we have shown that atherogenic risk factors are present in the pediatric population and may be associated with endothelial dysfunction, even at very young ages. Despite increasing concerns that children with rheumatologic disorders may be at increased risk of developing premature atherosclerosis, traditional and sociodemographic features may play a greater role in the ultimate development of cardiovascular disease.

Highlights

Children with juvenile dermatomyositis (JDM), the most common inflammatory myopathy of childhood, may be at increased risk of premature atherosclerosis given a host of traditional and non-traditional risk factors
There were no statistically significant differences between groups with regards to age, gender, race or body mass index (BMI); 55% of pediatric controls reported Hispanic ethnicity compared to 35% in the JDM group
Annual medium household income by zip-code was reviewed for each study participant; 70% of pediatric controls and 45% of JDM patients were found to live in a household with a medium income less than $50,000/year (Fig. 1)

Summary

Introduction

Children with juvenile dermatomyositis (JDM), the most common inflammatory myopathy of childhood, may be at increased risk of premature atherosclerosis given a host of traditional and non-traditional risk factors. Premature atherosclerosis has been demonstrated among young patients with systemic lupus erythematosus (SLE) and Kawasaki disease (KD), using non-invasive ultrasound techniques including carotid intima-media thickness (CIMT) and flow-mediated dilation (FMD) [4, 8]. This finding is not surprising given the evidence that atherosclerosis is, in large part, an inflammatory disorder initiated and propagated by both humoral and cellular immunity [9, 10]. Higher rates of traditional atherosclerotic risk factors have been reported in adult patients with idiopathic inflammatory myopathies as compared to the general population [12, 17, 22]

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