Pediatric interventions using noninvasive vascular health indices.

Abstract

Heart disease is currently the leading cause of death in the world.1 It is estimated that greater than a third of the population in the United States has at least 1 type of cardiovascular disease.2 Although its clinical manifestations typically emerge in middle age, the atherosclerotic process begins in childhood.3 Proatherosclerotic fatty streaks and raised lesions, which are deposits of cholesterol/esters and fibrous plaques, respectively, are seen in children as young as 3 and increase in number and severity with age.3 Children with cardiovascular risk factors will develop atherosclerosis in adulthood at an accelerated rate.4 Therefore, interventions during childhood and adolescence could prevent the development of atherosclerosis in adulthood. Noninvasive modalities are ideal to assess these interventions in children because of their safety and feasibility.5 Some of these techniques include carotid intima-media thickness (IMT) by ultrasound, endothelial function by reactive hyperemia, and arterial stiffness by tonometry, oscillometry, and ultrasound.5–7 This article reviews studies of diet, exercise, and pharmacological interventions using noninvasive vascular health indices as outcomes in children and adolescents. An understanding of past investigations will guide future research in this field. ### Endothelial Function One of the earliest detectable cardiovascular changes associated with disease is endothelial dysfunction. In normally functioning vasculature, the endothelium produces nitric oxide in response to shear stress caused by increased blood flow,8 which results in compensatory vasodilatation. If an appropriate degree of dilation is not reached, this is classified as endothelial dysfunction. Endothelial dysfunction can be caused by the reduction of nitric oxide being released or the inactivation of nitric oxide by an excess of reactive oxidative particles.9 Endothelial dysfunction is proinflammatory and prothrombotic.10 However, unlike atherosclerosis, endothelial dysfunction is treatable and reversible.11 Reactive hyperemia assessment is an established noninvasive method to assess endothelial function …