Cardiovascular Risk Factors In Children Research Articles

Metal mixture exposures and serum lipid levels in childhood: the Rhea mother-child cohort in Greece.

Growing evidence suggests that cardiovascular disease develops over the lifetime, often beginning in childhood. Metal exposures have been associated with cardiovascular disease and important risk factors, including dyslipidemia, but prior studies have largely focused on adult populations and single metal exposures. To investigate the individual and joint impacts of multiple metal exposures on lipid levels during childhood. This cross-sectional study included 291 4-year-old children from the Rhea Cohort Study in Heraklion, Greece. Seven metals (manganese, cobalt, selenium, molybdenum, cadmium, mercury, and lead) were measured in whole blood using inductively coupled plasma mass spectrometry. Serum lipid levels included total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, and low-density lipoprotein (LDL) cholesterol. To determine the joint and individual impacts of child metal exposures (log2-transformed) on lipid levels, Bayesian kernel machine regression (BKMR) was employed as the primary multi-pollutant approach. Potential effect modification by child sex and childhood environmental tobacco smoke exposure was also evaluated. BKMR identified a positive association between the metal mixture and both total and LDL cholesterol. Of the seven metals examined, selenium (median 90.6 [IQR = 83.6, 96.5] µg/L) was assigned the highest posterior inclusion probability for both total and LDL cholesterol. A difference in LDL cholesterol of 8.22 mg/dL (95% CI = 1.85, 14.59) was observed when blood selenium was set to its 75th versus 25th percentile, holding all other metals at their median values. In stratified analyses, the positive association between selenium and LDL cholesterol was only observed among boys or among children exposed to environmental tobacco smoke during childhood. Growing evidence indicates that cardiovascular events in adulthood are the consequence of the lifelong atherosclerotic process that begins in childhood. Therefore, public health interventions targeting childhood cardiovascular risk factors may have a particularly profound impact on reducing the burden of cardiovascular disease. Although growing evidence supports that both essential and nonessential metals contribute to cardiovascular disease and risk factors, such as dyslipidemia, prior studies have mainly focused on single metal exposures in adult populations. To address this research gap, the current study investigated the joint impacts of multiple metal exposures on lipid concentrations in early childhood.

The role of sex on the prevalence of cardiovascular risk factors in children and adolescents with Type 1 diabetes: The SWEET international database

ObjectiveTo assess the prevalence of cardiovascular risk factors (CVRFs) in children and adolescents with type 1 diabetes (T1D) in the International SWEET registry and the possible role of clinical variables in modifying the risk of having single or multiple CVRFs. Study designThe study is a cross-sectional study. Cut-off points for CVRFs were fixed according to International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines and WHO parameters: LDL cholesterol (LDL-C) > 100 mg/dL; Systolic Blood Pressure (BP-SDS) > 90th percentile for sex, age, and height; BMI-SDS > 2SD for sex and age. Logistic regression models were applied to evaluate variables associated with at least 1 or 2 CVRFs among registry children and adolescents. Results29,649 individuals with T1D (6–18 years, T1D ≥ 2 years) participating in the SWEET prospective multicenter diabetes registry were included. In the cohort, 41 % had one or more CVRFs, and 10 % had two or more CVRFs. Thirty-five percent of enrolled individuals had LDL-C > 100 mg/dL, 26 % had BMI-SDS > 2SD, and 17 % had Systolic BP-SDS > 90th percentile. Females had higher frequency than males of having 1 or 2 CVRFs (45.1 % vs 37.4 %, 11.8 % vs 7.8 %; p < 0.001). Multivariable logistic regression models showed that sex (female), HbA1c category (>7.0 %), and age (>10 years) were associated with a higher chance of having at least 1 or 2 CVRFs (p < 0.001). ConclusionsIn children and adolescents with T1D, female sex, in addition to HbA1c above 7 %, and older age (>10 years) was associated with a higher risk of having at least a CVRF (LDL-C, BMI-SDS, BP) according to internationally defined cut-offs.

Physical Activity and Cardiovascular Risk Factors in Children from 4 to 9 Years of Age

BackgroundPhysical activity guidelines for children encourage moderate-to-vigorous intensity activities (MVPA); however, some studies have found that only vigorous intensity activities (VPA) might promote health benefits in young children. Thus, the aim of this study is to investigate cross-sectional and 5-year longitudinal associations of VPA and MVPA with cardiovascular disease (CVD) risk factors in childhood using compositional data analysis.ResultsThis study utilized data from the SPINACH study (n = 411). Physical activity was measured with accelerometers at 4- and 9-years of age. CVD risk factors were measured at 9-years of age, and included blood pressure (BP), lipid metabolism, and glucose metabolism biomarkers, as well as a continuous metabolic syndrome risk score (MetS). Cross-sectional and longitudinal linear regression models were built using compositional data analysis standards. Cross-sectionally, reallocating time to VPA from lower-intensity behaviours at 9-years was associated with lower waist circumference (B = − 3.219, P = 0.002), diastolic BP (B = − 1.836, P = 0.036), triglycerides (B = − 0.214, P < 0.001), glucose (B = − 0.189, P = 0.033), insulin (B = − 2.997, P < 0.001), and HOMA-IR (B = − 0.778, P < 0.001). Similarly, reallocating time to VPA at 4-years was associated with lower MetS (B = − 0.831, P = 0.049), waist circumference (B = − 4.211, P = 0.015), systolic BP (B = − 5.572, P = 0.015), diastolic BP (B = − 2.931, P = 0.044), triglycerides (B = − 0.229, P = 0.034), glucose (B = − 0.325, P = 0.032), insulin (B = − 5.114, P = 0.001), and HOMA-IR (B = − 0.673, P = 0.001) at 9-years. Reallocations of time to MVPA at 4- or 9-years were not associated with CVD risk factors at 9-years.ConclusionsVPA was associated with CVD risk factors in children both cross-sectionally (9-years) and longitudinally (at 4- and 9-years). MVPA seemed not to be a stimulus of enough intensity to trigger these potential cardiometabolic benefits in healthy children. Thus, these findings suggest the importance of higher intensity activities, i.e., VPA already in early childhood for cardiometabolic health.

Association of adipocytokines and adipocytokine ratios with cardiovascular risk factors in Japanese preadolescents.

Asians are particularly susceptible to obesity-associated disorders and rapid progression of obesity from childhood to adulthood. Data on the association between adipocytokine parameters, particularly adipocytokine ratios, and cardiovascular risk factors in childhood remain limited. Herein, we assessed the association of resistin, adiponectin, and leptin levels and leptin/adiponectin and resistin/adiponectin ratios with selected cardiovascular risk factors and the influence of unhealthy weight on such associations in children aged 9-10 years. We included 380 children aged 9-10 years from three public elementary schools in Japan. The body mass index (BMI) was significantly higher in male preadolescents than in female adolescents (median 16.5 kg/m2 vs. 16.2 kg/m2, p=0.032). No differences in height, weight, waist circumference (WC), waist/height ratio (W/Hr), total cholesterol and high-density lipoprotein cholesterol levels, or atherosclerosis index (AI) were observed between the sexes. Of the adipocytokine levels and ratios analyzed, only the leptin level and leptin/adiponectin ratio (L/Ar) were strongly and significantly positively correlated with the cardiovascular risk factors WC, W/Hr, and BMI (all p<0.05). The AI was not strongly correlated with any adipocytokine levels or ratios. Apart from the strong positive correlation between the L/Ar and W/Hr, no other significant associations were observed between any of the adipocytokine levels or ratios and the selected cardiovascular risk factors. Our findings confirmed the value of adipocytokine ratios in risk assessment in pediatric populations, with leptin levels and leptin/adiponectin ratios strongly correlating with risk factors in children aged 9-10 years.

Abstract MP38: Higher Childhood Cardiovascular Risk Score is Associated With Worse Physical, Social and Emotional Functioning in Adulthood

Introduction: Childhood cardiovascular risk factors have been associated with increased risk of adult cardiovascular disease, but how they are associated with adult physical, emotional and social functioning is not well understood. Hypothesis: We addressed the hypothesis that the International Childhood Cardiovascular Cohort (i3C) Consortium childhood risk score would be associated with worse physical, social and emotional functioning in adulthood. Methods: The i3C childhood combined risk score is the average of five childhood risk factors (body mass index, systolic blood pressure, youth smoking, total cholesterol and triglycerides) on the z-score scale. Self-reported measures of physical (e.g., pain, functioning, fatigue), social (e.g., social isolation, satisfaction with social role) and emotional functioning (e.g., anxiety, depression) were assessed in adulthood in a subset of two i3C cohorts, the NHLBI Growth and Health Study (NGHS) and the Princeton Lipid Research Study (PLRS). Potential covariates included cohort (as a proxy for age, given no overlap in ages between cohorts), sex, race (Black vs. White), own education, parental education, marital status, and self-reported hypertension, diabetes and cancer. Interactions between the i3C risk score and cohort (age) were evaluated. Results: Ninety-two NGHS (100% female, 46% Black, mean±SD age 44.5±0.6 years) and 75 PLRS (77% female, 31% Black, 60.6±3.4 years) participants were included in analyses. In adjusted models, a higher i3C risk score was associated with worse physical functioning, global pain score, pain interference with everyday activities, and fatigue in the older PLRS participants, but only with global pain score in the younger NGHS participants (all p[int]&lt;0.05 except global pain). Higher i3C childhood risk score was associated with greater sleep-related impairment in PLRS, but with less impairment in NGHS participants (p[int]=0.03). Higher i3C childhood risk score was also associated with higher depression scores and less satisfaction with social roles in PLRS participants but not NGHS participants (p[int]=0.02 and 0.04, respectively). There was no significant relationship of i3C risk score with sleep quality, friendships, social isolation or anxiety. Conclusions: In conclusion, higher childhood cardiovascular risk factors are associated with worse physical, social and emotional health in adulthood, even in this limited sample of predominantly Black and White women followed from childhood. These effects are more prominent in older than younger adults, when issues such as pain and sleep problems become more prevalent.

Increased Carotid Intima-media Thickness and Its Association with Carbohydrate Metabolism and Adipocytokines in Children Treated with Recombinant Growth Hormone.

Reports on the association between growth hormone therapy and cardiovascular risk factors in children are limited. This study aimed to evaluate carotid intima-media thickness (cIMT) in children treated with recombinant human growth hormone (rhGH) and assess the effects of rhGH therapy and changes in serum carbohydrate metabolism, lipid profile and adipocytokines on cIMT. Seventy-one isolated idiopathic GH deficiency (GHD) children and 44 age- and sex-matched, healthy controls were enrolled in this study. The study group was divided into two subgroups according to insulin resistance (IR) on oral glucose tolerance tests. Insulin secretion (HOMA B, total insulin) and sensitivity (HOMA-IR, QUICKI, Matsuda) indices were calculated. cIMT was measured and the standard deviation scores (SDS) were calculated. Associations between cIMT-SDS and insulin secretion and sensitivity indices, serum lipid levels, adipocytokines (leptin, resistin, ghrelin), and the other rhGH treatment-related factors were evaluated. The cIMT-SDS was increased in GHD children treated with rhGH compared to controls (0.02 (2.27) vs -1.01 (1.63), p=0.003). cIMT-SDS did not differ between children on rhGH treatment with or without IR. High cIMT-SDS was significantly associated with higher serum ghrelin level and lower serum high density lipoprotein level (ß=0.491, p=0.001 and ß= -0.027, p=0.017), but not with BMI-SDS, blood pressure, insulin secretion and sensitivity indices, or dose and duration of rhGH therapy. Our findings showed that GHD children treated with rhGH have increased cIMT. Alterations in carbohydrate metabolism were not associated with cIMT in children treated with rhGH. GH therapy per se appears to be associated with this increased cIMT but causality should be elucidated in further studies. cIMT also appears to be associated with higher ghrelin and lower HDL levels.

Cardiovascular Risk Factors in Children and Adolescents with Type 1 Diabetes Mellitus: The Role of Insulin Resistance and Associated Genetic Variants

Introduction: Type 1 diabetes (T1D) is associated with an increased risk of cardiovascular disease. Insulin resistance is an important cardiovascular risk factor (CVRF), also in subjects with T1D, but the influence of the genetic predisposition of insulin resistance on cardiovascular risk is still unknown in T1D. We aimed to determine whether a genetic score composed of six variants, previously associated with insulin resistance and type 2 diabetes (T2D) risk, associates with insulin sensitivity and known CVRFs in children and adolescents with T1D. Materials and Methods: 330 children and adolescents (174 males; mean age 15.7 ± 3.5 years) with T1D were genotyped for the following genetic variants: rs1801278 (IRS1), rs1044498 (ENPP1), rs2295490 (TRIB3), rs1801282 (PPARG), rs780094 (GCKR), and rs35767 (IGF1). An additive genetic risk score (GRS) and cardiovascular risk score (CVRS) were calculated. Anthropometric, glycemic control, insulin sensitivity, blood pressure, and biochemical parameters were assessed. Multivariate regression between evaluated phenotypes and GRS was performed. Results: We found a significant association between the GRS and estimated insulin sensitivity (β = −0.027 [−0.040 to −0.013], R² = 0.86, p≤ 0.001), diastolic blood pressure (β = 0.68 [0.08–1.27], R² = 0.20, p = 0.026), triglycerides (β = 4.26 [1.74–6.77], R² = 0.13, p = 0.001), waist to height ratio (β = 0.003 [0.001–0.006], R² = 0.75, p = 0.010), non-HDL-cholesterol (β = 3.63 [1.39–5.87], R² = 0.12, p = 0.002), and CVRS (β = 0.063 [0.008–0.118], R² = 0.19, p = 0.025), independent of age, sex, BMI, pubertal stage, diabetes duration, glycated hemoglobin, type of treatment, and total insulin requirement. The addition of the GRS to established clinical risk factors significantly improved the discriminatory capability of the regression model for predicting subjects with more CVRFs (C-statistic 0.89 [95% CI: 0.84–0.95] versus 0.83 (0.73–0.93); p = 0.037). Conclusions: Insulin resistance and T2D risk-associated genetic variants influence insulin sensitivity and known CVRFs in children and adolescents with T1D.

Childhood cardiovascular risk factors associated with adult cardiac events

Childhood cardiovascular risk factors associated with adult cardiac events

Prenatal exposure to Nitrogen Oxides and Waist-to-Height Ratio (WHtR) as a cardiovascular risk factor in school-aged children participants of the POSGRAD Cohort

Prenatal exposure to Nitrogen Oxides and Waist-to-Height Ratio (WHtR) as a cardiovascular risk factor in school-aged children participants of the POSGRAD Cohort. Priscila Ceja Esparza¹, Albino Barraza Villarreal¹, Leticia Hernández Cadena¹ ¹ Department of Environmental Health, The National Institute of Public Health of Mexico (INSP) Background and Aim: Prenatal exposure to NOx may increase the risk of obesity and cardiovascular risk factors in children. This study aims to evaluate the relationship between prenatal exposure to NOx and its effect on the behavior of the WHtR in school-aged children from the ages of 7 to 12 years old and to determine if the prenatal supplementation with docosahexaenoic acid (DHA) influences the outcome. Methods: We included 642 mother-child from the POSGRAD cohort. Land use regression models were performed to estimate exposure to NOx (NO, NO2 and NOx) using the results of passive outdoor monitoring from a representative sample of participant households. Child anthropometrics were taken yearly and WHtR was calculated. The association between prenatal exposure to NOx and WHtR was measured through a logistic random-effects model by tertiles of exposure and considering the prenatal supplementation status. Results: We found a significant difference in the risk of having a WHtR &amp;#x3e;= 0.5, on the second tertile of exposure for NOx between the supplemented (OR= 0.59, IC 95%: 0.10-3.49, p = 0.56) and placebo (OR=13.74, IC 95%: 1.94-97.24, p=0.01) groups when compared with the lowest tertile; in the third tertile the ORs were bigger for both groups, however, these were not significant. Conclusions: Prenatal exposure to NOx can affect the WHtR outcome in children and prenatal supplementation with DHA can decrease this effect. The lack of protection of DHA at higher levels of exposure could suggest a need for higher doses of supplementation. Key Words: Prenatal, Waist-to-Height Ratio, Nitrogen Oxides, Cardiovascular Risk

Increased prevalence of cardiovascular risk factors in children and adolescents with type 1 diabetes and hypertension: The SWEET international database.

To investigate the prevalence of modifiable cardiovascular risk factors (CVRFs), including dyslipidaemia, obesity and high glycated haemoglobin (HbA1c) concentration, in patients with type 1 diabetes (T1D), and to evaluate their association with blood pressure (BP) categories. We analysed 21 634 children and adolescents with T1D from the SWEET international database with office BP values assessed at a three or more visits within a year from 2010 to 2021. Participants were classified into a normotensive group, a group with elevated BP (90 to 94th percentile) or a hypertensive group (≥95th percentile), based on the median BP for the visits within the last treatment year. The prevalences of dyslipidaemia [cholesterol ≥ 5.18 mmol/L (200 mg/dL) and/or HDL cholesterol ≤ 1.036 mmol/L (40 mg/dL) and/or LDL cholesterol ≥ 2.59 mmol/L (100 mg/dL)], obesity (body mass index ≥2 standard deviation score) and elevated HbA1c [≥ 75 mmol/mol (9%)] were evaluated in patients within each BP group. Patients with hypertension/elevated BP had less favourable lipid profiles, and a higher prevalence of obesity and HbA1c ≥ 75 mmol/mol than normotensive patients. A total of 38.4% of hypertensive patients and 36.0% of those with elevated BP had one CVRF, 15.1% and 10.1%, respectively, had two CVRFs, and 2.3% and 0.8%, respectively, had three CVRFs. Patients with hypertension/elevated BP had a higher prevalence of one or more CVRFs versus normotensive patients (P< 0.001). Obesity was the CVRF most strongly related to hypertension. Girls had a higher prevalence of one or more CVRFs than boys. Similar results were found in patients aged ≥13 years with hypertension compared to those aged <13 years. The prevalence of modifiable CVRFs is higher in children and adolescents with T1D who have elevated BP/hypertension than in those with normotension, suggesting that they are more vulnerable to future morbidity and mortality requiring early detection and intervention.

Childhood cardiovascular risk factors and adult cardiovascular events

Brief summary: This prospective cohort study leveraged data from the International Childhood Cardiovascular Cohorts (i3C) Consortium, including 42 324 participants at baseline and followed-up over a mean of 35 years, in order to investigate associations between cardiovascular risk factors (CVRF, including body-mass index, systolic blood pressure, total cholesterol levels, triglycerides, and smoking) in childhood (mean age 11.8 years) with fatal and non-fatal cardiovascular events in adulthood (mean age 47 years). They showed that increases in each individual CVRF in childhood, and a combined-CVRF risk score, were associated with higher risks of fatal and non-fatal cardiovascular disease events in adults, robust to adjustment for adult CVRF levels.

Prediction of psychological, spiritual, and social health with cardiovascular risk factors in children and adolescents

Objectives: Children are the most important asset in any country. Since cardiovascular diseases are built up little by little from childhood, this study attempted to detect the relationship between psychological, spiritual, and social health conditions and cardiovascular risk factors in children.&#x0D; Methods: This study is a cross-sectional study performed on 1035 children aged 6-18 years by multi-stage random cluster sampling in 2016 in Yazd province of Iran. The lifestyle questionnaire (LSQ) was used to collect data. In addition, demographic information (i.e., age and sex) and cardiac risk factors were measured. Logistic regression and t-test were used to analyze the data.&#x0D; Results: In this study, by increasing the mean score of psychological and spiritual health, fasting blood sugar (FBS) decreased significantly (OR = 0.14, 95% CI: 0.02-0.80, P trend = 0.003 and OR = 0.05, 95% CI: 0.01, -0.28, P trend = 0.013). Also, with increasing the mean score of spiritual health, body mass index (BMI) reduced significantly too. (OR = 0.35, 95% CI: 0.18-0.66, P trend = 0.014). However, social health failed to be significantly associated with cardiac risk factors.&#x0D; Conclusions: FBS in children aged 6-18 years is affected by psychological and spiritual health. BMI and the level of spiritual health also turned out to be inversely related. As a result, psychological and spiritual health dimensions should be improved to lower the risk factors for cardiovascular diseases in children aged 6-18 years.

HDL-Cholesterol in Children and Adolescents with Congenital Heart Disease

Background Children and adolescents with congenital heart disease may be more likely to develop atherogenic cardiovascular diseases in adulthood. Therefore, the early identification of risk factors and intervention in childhood may be crucial for a good quality of life and longevity. Objectives To describe the distribution of high-density lipoprotein-cholesterol (HDL-c) levels and its association with socioeconomic, clinical and cardiovascular risk factors in children and adolescents with congenital heart disease. Methods Cross-sectional study with children and adolescents aged between 5 [...]

Efficacy and Safety of a Polysaccharide-Based Natural Substance Complex in the Treatment of Obesity and Other Metabolic Syndrome Components: A Systematic Review

Introduction: Metabolic syndrome (MetS) is increasingly common in adults as well as in children and adolescents. However, preventing and treating MetS is one of the most pressing challenges for public health services worldwide. At present, the only approved treatments for MetS are dietary changes and physical activity, which are associated with a high rate of non-compliance. On the contrary, no drugs are licensed to treat metabolic syndrome, although a number of drugs are used to treat individual metabolic abnormalities, which increases the risk of adverse events, particularly in children. Policaptil Gel Retard® (PGR), an oral macromolecule complex based on polysaccharides, has been demonstrated to significantly reduce body weight, peak blood glucose (BG) levels, insulin levels, and lipid levels, providing an interesting non-pharmacological therapeutic option for MetS-associated metabolic abnormalities, especially in younger patients.Aims: To review available studies on the use of PGR in children, adolescents, or adults with obesity or metabolic syndrome.Methods: A systematic search of electronic databases for PGR and MetS. A total of six studies were identified and included.Results: Across four randomized clinical studies and one retrospective clinical study including a total of 359 obese children and adolescents with or without MetS and 157 overweight/obese adults with or without MetS and/or T2DM, a single dose of PGR resulted in a reduction in appetite and postprandial triglyceride levels in younger patients and peak postprandial BG levels in adults. Decreased lipid levels were observed in adults following a normocaloric diet who received PGR for 30 days. As a long-term treatment, in combination with a low-glycemic index diet with or without metformin, PGR resulted in reduced body mass index and waist circumference, improved insulin sensitivity with reduction of glucose-metabolism abnormalities, increased insulin reserve and, finally, an improved circulating lipid profile, regardless of age. No safety issues were reported.Conclusion: Policaptil Gel Retard® is an effective and safe non-pharmacological approach to improve the treatment of MetS-associated cardiovascular risk factors in children, adolescents, and adults.

Childhood Cardiovascular Risk Factors and Adult Cardiovascular Events

BackgroundChildhood cardiovascular risk factors predict subclinical adult cardiovascular disease, but links to clinical events are unclear.MethodsIn a prospective cohort study involving participants in the International Childhood Cardiovascular Cohort (i3C) Consortium, we evaluated whether childhood risk factors (at the ages of 3 to 19 years) were associated with cardiovascular events in adulthood after a mean follow-up of 35 years. Body-mass index, systolic blood pressure, total cholesterol level, triglyceride level, and youth smoking were analyzed with the use of i3C-derived age- and sex-specific z scores and with a combined-risk z score that was calculated as the unweighted mean of the five risk z scores. An algebraically comparable adult combined-risk z score (before any cardiovascular event) was analyzed jointly with the childhood risk factors. Study outcomes were fatal cardiovascular events and fatal or nonfatal cardiovascular events, and analyses were performed after multiple imputation with the use of proportional-hazards regression.ResultsIn the analysis of 319 fatal cardiovascular events that occurred among 38,589 participants (49.7% male and 15.0% Black; mean [±SD] age at childhood visits, 11.8±3.1 years), the hazard ratios for a fatal cardiovascular event in adulthood ranged from 1.30 (95% confidence interval [CI], 1.14 to 1.47) per unit increase in the z score for total cholesterol level to 1.61 (95% CI, 1.21 to 2.13) for youth smoking (yes vs. no). The hazard ratio for a fatal cardiovascular event with respect to the combined-risk z score was 2.71 (95% CI, 2.23 to 3.29) per unit increase. The hazard ratios and their 95% confidence intervals in the analyses of fatal cardiovascular events were similar to those in the analyses of 779 fatal or nonfatal cardiovascular events that occurred among 20,656 participants who could be evaluated for this outcome. In the analysis of 115 fatal cardiovascular events that occurred in a subgroup of 13,401 participants (31.0±5.6 years of age at the adult measurement) who had data on adult risk factors, the adjusted hazard ratio with respect to the childhood combined-risk z score was 3.54 (95% CI, 2.57 to 4.87) per unit increase, and the mutually adjusted hazard ratio with respect to the change in the combined-risk z score from childhood to adulthood was 2.88 (95% CI, 2.06 to 4.05) per unit increase. The results were similar in the analysis of 524 fatal or nonfatal cardiovascular events.ConclusionsIn this prospective cohort study, childhood risk factors and the change in the combined-risk z score between childhood and adulthood were associated with cardiovascular events in midlife. (Funded by the National Institutes of Health.)

Childhood cardiovascular risk factors lead to heart disease in adults.

Childhood cardiovascular risk factors lead to heart disease in adults.

Cardiovascular Risk Factors in Children and Adolescents with Fontan Circulation

Background: Long-term outcomes of patients with Fontan circulation are uncertain regarding the prevalence and role of risk factors (RFs) such as increased body mass index (BMI), arterial hypertension, and hypercholesterolemia. Objectives: To describe the prevalence of RFs in patients with univentricular heart, with variable follow-up times. Methods: This mixed cohort study was performed with 66 patients, who underwent blood count, fasting blood glucose, C-reactive protein (CRP), and lipid profile tests; systolic/diastolic blood pressure (SBP/DBP) measurements; and anthropometric and sociodemographic [...]

Cardiovascular Risk Factors in Childhood and Adolescence

According to the World Health Organization (WHO), cardiovascular diseases (CVDs) are the leading cause of death globally, taking an estimated amount of 17 [...].

A mediation analysis on the relationship between dietary glycemic load, obesity and cardiovascular risk factors in children.

Adiposity may mediate the effect of dietary glycemic load (GL) on lipid profiles in children, as studies have shown an association between dietary GL and adiposity and between adiposity and lipid profiles. Our objective was to evaluate the role of adiposity as a mediator in the association between dietary GL and lipid profiles after 2 years. The Quebec Adipose and Lifestyle InvesTigation in Youth study included 630 children, 8-10 years old at recruitment with at least one parent with overweight or obesity with 2-year follow-up. Three baseline 24-h dietary recalls were administered by a dietitian at baseline. Child and parent characteristics were obtained through direct measurement (blood lipids, anthropometrics) or questionnaires (socio-economic characteristics). Indicators of adiposity, including body mass index (BMI) z-score and percent body fat, were the mediators of interest. A conventional approach using the Baron and Kenny method was used. A causal approach using marginal structural models (MSM) was used to estimate the controlled direct effect. Mean age at baseline was 9.6 years and 33% were overweight or obese. Both methods revealed that the effect of GL on blood lipids was mediated by adiposity. The weighted MSM did not show evidence of a direct effect (TG: β =;0.01, 95% CI = -0.01,0.02; HDL: β = 0.005, 95%CI = -0.002,0.01), whereas the conventional method did for TG but not HDL (TG:β = 0.04, 95%CI = 0.01,0.07; HDL: β = -0.01, 95%CI = -0.03,0.01). Adiposity contributes substantially to the association between GL and blood lipids. The choice of approach for mediation analysis should be based on the fulfilment of conditions of each method.

The association of allergic asthma and carotid intima-media thickness in adolescence: data of the prospective early vascular ageing (EVA)-Tyrol cohort study

BackgroundIn recent years, there has been increasing evidence that asthma is associated with atherosclerosis and cardiovascular disease. However, data in children and adolescents are scarce and conflicting. We aimed to assess the impact of asthma with and without an allergic component on the carotid intima-media thickness in a large pediatric population.MethodsThe community-based early vascular ageing-Tyrol cohort study was performed between May 2015 and July 2018 in North, East (Austria) and South Tyrol (Italy) and recruited youngster aged 14 years and above. Medical examinations included anthropometric measurements, fasting blood analysis, measurement of the carotid intima-media thickness by high-resolution ultrasound, and a physician guided interview.ResultsThe mean age of the 1506 participants was 17.8 years (standard deviation 0.90). 851 (56.5%) participants were female. 22 subjects had a physician diagnosis of non-allergic asthma, 268 had inhalative allergies confirmed by a positive radio-allergo-sorbent-test and/or prick test, and 58 had allergic asthma. Compared to healthy controls, participants with non-allergic asthma (411.7 vs. 411.7 µm; p = 0.932) or inhalative allergy (420.0 vs. 411.7 µm; p = 0.118) did not have significantly higher carotid intima-media thickness (cIMT). However, participants with allergic asthma had significantly higher cIMT (430.8 vs. 411.7; p = 0.004) compared to those without and this association remained significant after multivariable adjustment for established cardiovascular risk factors.ConclusionAllergic asthma in the youth is associated with an increased carotid intima-media thickness. Physicians should therefore be aware of allergic asthma as a potential cardiovascular risk factor in children and adolescents.Trial Registration Number The EVA-Tyrol Study has been retrospectively registered at clinicaltrials.gov under NCT03929692 since April 29, 2019.