Abstract
SummaryBackgroundSince the cardiovascular (CV) risk score in the young population, children and adolescents, is underestimated, especially in developing countries such as Montenegro, where a strong interaction exists between the genetically conditioned CV risk and environmental factors, the purpose of this study was to estimate CV risk in apparently healthy adolescent girls. Moreover, we aimed to test some new, emerging CV risk factors and their interaction with the traditional ones, such as obesity. Precisely, we aimed to assess the impact of low bilirubin levels, as a routine biochemical parameter, as an additional risk factor for atherosclerotic disease in the adult phase.MethodsForty-five obese adolescent girls (mean age 17.8±1.22 years) and forty-five age- and sex-matched normal weight controls, all nonsmokers, were included. Anthropometric and biochemical parameters were measured. Cardiovascular Risk Score (CVRS) was calculated by adding the points for each risk factor (e.g. sex, HDL-c, non-HDL-c, blood pressure and fasting glycemia).ResultsA significant positive relationship between CVRS and ALT, hsCRP and TG/HDL-c, but an opposite relationship between CVRS and total bilirubin were found (P<0.001). Multiple linear regression analysis showed that higher waist circumference (WC) and LDL-c, but lower HDL-c were independent predictors of lower bilirubin values (adjusted R2=0.603, P<0.001).ConclusionsObese adolescent girls are at an increased risk of cardiovascular disease late in life. In addition to the traditional risk factors, total bilirubin may have the potential to discriminate between low and higher risk for cardiovascular disturbances in healthy adolescent girls.
Highlights
Traditional coronary heart disease risk factors are recognized and should be quantified even in children and adolescents in order to detect young individuals with a high probability of having increased risk for cardiovascular disease late in life [1].The effect of obesity on cardiovascular disease (CVD) risk often tracks from childhood and adolescence, even if frank heart disease rarely presents before adulthood [2, 3, 4].Oxidative stress has appeared in recent years as a hallmark of the obese state, intrinsically linked to chronic low-grade inflammation [5]
Beside the expected positive relationship between cardiovascular risk score and ALT activity, High sensitivity C-reactive protein (hsCRP) level and TG/high density lipoprotein cholesterol (HDL-c) ratio, which are known as established CV risk factors [9, 14, 15], we revealed a significant opposite relationship between cardiovascular risk score and bilirubin concentrations in the group of adolescent girls (Figure 2)
Construction of a model consisting of 4 Risk Score formula independent parameters by using logistic regression analysis showed that the new comprehensive Receiver Operating Characteristic (ROC) curve (Figure 3) has outstanding discriminatory capability [11]
Summary
Traditional coronary heart disease risk factors are recognized and should be quantified even in children and adolescents in order to detect young individuals with a high probability of having increased risk for cardiovascular disease late in life [1].The effect of obesity on cardiovascular disease (CVD) risk often tracks from childhood and adolescence, even if frank heart disease rarely presents before adulthood [2, 3, 4].Oxidative stress has appeared in recent years as a hallmark of the obese state, intrinsically linked to chronic low-grade inflammation [5]. Hypertrophied adipocytes have been reported as a significant source of reactive oxygen species (ROS), promoting adipose tissue dysfunction by increased expression of adipokines and macrophage infiltration in the adipose tissue, further leading to overproduction of ROS and inflammatory cytokines, and altogether establishing a systematic feedback-loop between inflammation and oxidative stress in obese adipose tissue [5, 6]. High levels of ROS generated by hypertrophied adipocytes impact many metabolic signaling pathways (e.g., insulin sensitivity, promote inflammation, and alter lipid metabolism or endothelial dysfunction). Vascular damage and inflammation participate actively in ROS generation, entertaining a vicious circle and maintaining high levels of oxidative stress, as an important contributor to obesity-related disorders such as atherosclerosis [5]
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