Endothelial Function In Children Research Articles

Vascular effects of Kawasaki disease

There always has been concern that an episode of Kawasaki disease could have long-lasting effects on the coronary arteries and other components of the cardiovascular system. In this issue of The Journal, Ishikawa and Iwashima report the results of a study to evaluate vascular function using endothelial function and vascular structure using carotid intima-media thickness in children in the 5 years after an acute episode of Kawasaki disease. They found that the children had evidence of endothelial dysfunction, but no evidence of vascular structural changes.The clinical importance of these findings is not completely clear. It is known that endothelial dysfunction is associated with increased risk of cardiovascular disease in adults. It will be important to understand whether these changes persist over a longer period of time. The fact that endothelial dysfunction is associated with a longer duration of fever during the acute episode suggests that early detection and treatment of Kawasaki disease may help prevent vascular abnormalities.Article page 1117▶ There always has been concern that an episode of Kawasaki disease could have long-lasting effects on the coronary arteries and other components of the cardiovascular system. In this issue of The Journal, Ishikawa and Iwashima report the results of a study to evaluate vascular function using endothelial function and vascular structure using carotid intima-media thickness in children in the 5 years after an acute episode of Kawasaki disease. They found that the children had evidence of endothelial dysfunction, but no evidence of vascular structural changes. The clinical importance of these findings is not completely clear. It is known that endothelial dysfunction is associated with increased risk of cardiovascular disease in adults. It will be important to understand whether these changes persist over a longer period of time. The fact that endothelial dysfunction is associated with a longer duration of fever during the acute episode suggests that early detection and treatment of Kawasaki disease may help prevent vascular abnormalities. Article page 1117▶ Endothelial Dysfunction in Children within 5 Years after Onset of Kawasaki DiseaseThe Journal of PediatricsVol. 163Issue 4PreviewTo evaluate endothelial function in children within 5 years after the onset of Kawasaki disease (KD). Full-Text PDF

Endothelial Dysfunction in Children within 5 Years after Onset of Kawasaki Disease

To evaluate endothelial function in children within 5 years after the onset of Kawasaki disease (KD). A total of 46 children were enrolled prospectively as follows: 9 patients with KD and coronary artery lesions composed group 1, 15 patients with KD but without coronary artery lesions composed group 2, and 22 healthy age- and sex-matched children composed group 3. Flow-mediated dilatation (FMD) of the brachial artery, intima-media thickness of the common carotid artery, and biologic characteristics were compared among the 3 groups. Differences in the factors associated with endothelial function after KD were examined as well. The mean age of the study group was 6.5 ± 1.7 years. The patients with KD were studied at a median interval of 3.3 years (IQR, 2.0-4.4 years) from the onset of disease. The percent FMD (%FMD) was significantly lower in group 1 patients (median, 4.4%; IQR, 2.6%-5.7%) compared with both group 2 (median, 9.1%; IQR 6.6%-10.7%; P < .01) and group 3 (median, 11.1%; IQR, 10.1%-13.9%, P < .01). The %FMD was statistically significantly lower in group 2 compared with group 3 (P < .05). There were no significant differences in the intima-media thickness among the 3 groups. There was a significant negative correlation between %FMD and the total duration of fever (r = -0.50; P = .013). The children with KD already had arterial endothelial dysfunction within 5 years after the onset of illness. The longer the duration of fever, the greater the risk of inflammation-induced endothelial dysfunction.

TREM-1 and Pentraxin-3 Plasma Levels and Their Association with Obstructive Sleep Apnea, Obesity, and Endothelial Function in Children

Obstructive sleep apnea (OSA) is a common health problem in children and increases the risk of cardiovascular disease (CVD). Triggering receptor expressed on myeloid cells-1 (TREM-1) plays an important role in innate immunity and amplifies inflammatory responses. Pentraxin-3 is predominantly released from macrophages and vascular endothelial cells, plays an important role in atherogenesis, and has emerged as a biomarker of CVD risk. Thus, we hypothesized that plasma TREM-1 and pentraxin-3 levels would be elevated in children with OSA. ONE HUNDRED SIX CHILDREN (MEAN AGE: 8.3 ± 1.6 y) were included after they underwent overnight polysomnographic evaluation and a fasting blood sample was drawn the morning after the sleep study. Endothelial function was assessed with a modified hyperemic test after cuff-induced occlusion of the brachial artery. Plasma TREM-1 and pentraxin-3 levels were assayed using commercial enzyme-linked immunosorbent assay kits. Circulating microparticles (MPs) were assessed using flow cytometry after staining with cell-specific antibodies. Children with OSA had significantly higher TREM-1 and pentraxin-3 levels (versus controls: P < 0.01, P < 0.05, respectively). Plasma TREM-1 was significantly correlated with both body mass index (BMI)-z score and the obstructive apnea-hypopnea index (AHI) in univariate models. Pentraxin-3 levels were inversely correlated with BMI-z score (r = -0.245, P < 0.01), and positively associated with endothelial MPs and platelet MPs (r = 0.230, P < 0.01 and r = 0.302, P < 0.01). Both plasma TREM-1 and pentraxin-3 levels were independently associated with AHI in multivariate models after controlling for age, sex, race, and BMI-z score (P < 0.001 for TREM-1 and P < 0.001 for pentraxin-3). However, no significant associations emerged between TREM-1, pentraxin-3, and endothelial function. Plasma TREM-1 and pentraxin-3 levels are elevated in pediatric OSA, and may play a role in modulating the degree of systemic inflammation. The short-term and long-term significance of elevated TREM-1 and pentraxin-3 in OSA-induced end-organ morbidity remains to be defined.

Folate Fortification and Supplementation Do Not Provide Vascular Health Benefits in Type 1 Diabetes

To evaluate the lowest effective dose-response of folic acid on endothelial function in children with type 1 diabetes. A randomized, double-blind, crossover, placebo-controlled trial was conducted in 20 children with type 1 diabetes (age range 10-18 years) after mandatory folate fortification in Australia. Each child received orally 4 interventions (1 per month)-3 folic acid doses (0.5, 2, and 5 mg) and 1 placebo dose--in random order. The primary outcome was 2-hour postintervention change in endothelial function measured with flow-mediated dilatation (FMD). Thirty-five children with type 1 diabetes from our folic acid interventional trial before folate fortification were used for comparison. All children completed the study. There were no differences in baseline FMD or folate status between the visits. Folic acid supplementation increased serum folate (P = .0001) and red cell folate (P < .0001), but none of the doses improved FMD (P = .96). Baseline serum folate and red cell folate levels and FMD and glyceryl trinitrate-mediated dilatation were significantly higher in these children compared with children from our trial before mandatory folate fortification (P = .0001, .0001, .014, and .04, respectively). Folate status and vascular function have improved in children with type 1 diabetes since the introduction of mandatory folate fortification, but the beneficial endothelial effects of additional folic acid are no longer present.

261: Endothelial function in children with sickle cell disease

Sickle cell anemia (SCA) is an inherited disorder characterized by recurrent painful crises with ischemia resulting from vascular occlusion. Reduction of the flow mediated dilatation (FMD), secondary to impaired release of substances such as nitric oxide, has been reported recently in adult patient with SCA, but little is known in childrens. (1) To describe the vascular abnormalities assessed carotid and brachial arteries by ultrasound in a population of children with a major sickle cell syndrome (SS). (2) To compare with controls (children of the same age with no cardiovascular risk factor). (3) To compare vascular parameters with clinical, biological and transcranial Doppler data. Thirty two patients with SCA were prospectively enrolled. Mean age was 12,3±4,5 years. Patients with SCA were closely matched for age, gender, to 50 healthy AA subjects. Carotid IMT, cross sectional compliance (CSC), distensibility (CSD) and FMD were determined non-invasively and compared among the two groups. FMD was significantly decreased in SCA patients vs controls (6,2±2,9 vs 8, 2±4%, p<0,05). Carotid IMT (0,45±0,03), CSC, CSD was comparable in SCA and controls. There was no correlation between FMD and age, number and severity of crises, hemoglobin and LDH level, transcranial Doppler. This study demonstrated endothelial dysfunction in children with SCA which could influence therapies in this population to prevent cardiovascular risk factor.

Impact of Sleep Respiratory Disorders on Endothelial Function in Children

Obstructive sleep apnea syndrome (OSAS) in children can induce endothelial dysfunction, a well-known early marker of atherosclerosis. The study aimed to evaluate a link among endothelial function (measured by flow-mediated vasodilation (FMD)), obesity (evaluated by body mass index (BMI)), and sleep disordered breathing (SDB), assessed with apnoea/hypopnoea index (AHI), in a paediatric population. We demonstrated that our little OSAS patients showed an impaired endothelial function as compared to controls. In particular, the higher the AHI, the worst the FMD values and thus the endothelial function. Although the population sample is small, this study demonstrated that OSAS could impair endothelial function and worsen cardiovascular risk profile since childhood.

Variação do diâmetro da artéria braquial em crianças obesas: presente e futuro

OBJETIVO: Revisão da literatura acerca do uso da medida da variação do diâmetro da artéria braquial por ultrassonografia de alta resolução (dilatação mediada por fluxo) como preditor de risco para doença cardiovascular em crianças e adolescentes obesos. FONTES DE DADOS: Levantamento de publicações indexadas no Medline/PubMed de trabalhos publicados entre 2002 e 2011, rastreadas com a combinação dos descritores: "endothelium", "child", "ultrasonography" e "obesity", além de estudos e textos clássicos sobre o tema. Foram encontradas 54 publicações e 32 delas foram incluídas na presente revisão do tema. SINTESE DOS DADOS: O estudo da disfunção endotelial tem sido empregado como preditor de risco para doenças cardiovasculares, tais como aterosclerose e doença cardíaca coronariana, visto que a lesão endotelial é um importante evento na fisiopatologia de tais doenças. CONCLUSÕES: A dilatação mediada por fluxo da artéria braquial mostra-se importante como ferramenta diagnóstica e prognóstica na avaliação da função endotelial de crianças e adolescentes com excesso de peso por ser um método não invasivo, com boa aplicabilidade quanto ao custo, à inocuidade e ao benefício.

Hypoglycemia, but not glucose variability, relates to vascular function in children with type 1 diabetes.

Chronic sustained hyperglycemia unequivocally predicts vascular disease in diabetes. However, the vascular risk of glucose variability, including hypoglycemia, is uncertain. Vascular dysfunction is present in children with type 1 diabetes and is a critical precursor of atherosclerosis. We aimed to evaluate the relationship between glucose variability and vascular function in children with type 1 diabetes. Fifty-two type 1 diabetes subjects (14 [SD 2.7] years old, 25 males) had continuous glucose monitoring that included 48 h of data used to evaluate glucose variability (mean amplitude of glycemic excursions [MAGE] and other measurements) and hypoglycemia indices (glycemic risk assessment diabetes equation [GRADE] hypoglycemia, Low Blood Glucose Index [LBGI], and observed duration of hypoglycemia). Children with type 1 diabetes and 50 age- and gender-matched controls had assessments of vascular function (flow-mediated dilatation [FMD] and glyceryl trinitrate-mediated dilatation [GTN]). Children with type 1 diabetes had lower FMD and GTN than controls (P=0.02 and P<0.001, respectively). GRADE hypoglycemia and LBGI were inversely related to FMD (r=-0.36, P=0.009 and r=-0.302, P=0.03, respectively) but did not relate to GTN. GRADE hypoglycemia was independently related to FMD (regression coefficient=-0.25±0.09, P=0.006). MAGE and other measurements of glucose variability measurements did not relate to FMD or GTN. Hypoglycemia, but not glucose variability, during continuous glucose monitoring relates to impaired vascular endothelial function in children with type 1 diabetes. Hypoglycemia may be an additional risk factor for early cardiovascular disease, but the effect of glucose variability, independent of glycosylated hemoglobin, on vascular function remains uncertain.

Endothelial function in children and adolescents with mucopolysaccharidosis

Although coronary artery pathology is a prominent feature of mucopolysaccharidosis (MPS), it may be underestimated by coronary angiography because of its diffuse nature. It is also generally assumed that cardiovascular risk is increased in MPS and reduced following hematopoietic stem cell transplantation (HSCT) or enzyme replacement therapy (ERT), but this has never been formally evaluated. Non-invasive methods of assessing vascular endothelial function may provide a measure of cardiovascular risk in MPS. We evaluated endothelial function, using digital reactive hyperemia, in youth with MPS and in healthy controls. Digital reactive hyperemic index (RHI) was measured in 12 children and adolescents (age 10.3 ± 3.9 years old; 11 boys) with treated MPS and nine age- and gender-matched (11.4 ± 4.0; 8 boys) healthy controls. An independent t-test was used to compare RHI between individuals with MPS and controls. Children and adolescents with MPS (MPS type II: N = 5; type I: N = 4; type VI: N = 3) whether treated by HSCT (N = 4) or ERT (N = 8) had significantly lower RHI compared to controls (MPS 1.22 ± 0.19 vs. controls 1.46 ± 0.32, p < 0.05). These preliminary findings suggest that children and adolescents with treated MPS have significantly poorer endothelial function when compared to healthy controls. Further investigation into the utility of endothelial function for risk stratification and the long term implications of reduced endothelial function in MPS is warranted.

The Profile of Endothelial Function in Children with ALL Is Associated with the Risk Stratification Determining the Outcome – a Pilot Study

Abstract 4230 Background:Endothelial dysfunction (ED) is characterized by impaired balance between pro- and anti-aggregatory, pro- and anti-inflammatory factors as well as vasodilative and vasoconstrictive action of numerous metabolic and signaling pathways. ED is an important factor worsening the outcome in severe diseases. The aim of this study was to assess if the profile of endothelial function during the treatment of ALL might be associated with the risk stratification and with the outcome. Material and Methods:N=18 children at age of 4–18 years with ALL, treated with the ALLIC- BFM 2002 protocol were investigated. Plasma levels of the NO pathway metabolites (L-Arginine, ADMA – an endogenous competive eNOS inhibitor), markers of endothelial inflammatory and aggregatory function (VCAM-1, ICAM-1, E-selectin, P-selectin and PAI-1), lipid peroxidation (MDA – malonyldialdehyde) were analyzed at baseline, then during the 33rd and 78th day of treatment. Results were compared between three subgroups: standard risk, intermediate risk and high risk. Results:Subjects in the high risk groups were characterized by increased baseline lipid peroxidation, as assessed by the MDA levels in comparison to those in the standard risk group (8.56±2.14U/ml vs. 3.57±0.81U/ml, respectively, p<0.05). In the high risk group low E-selectin levels at baseline (32.1±6.1ng/ml vs. 101.3±11.8ng/ml in the standard risk group, respectively, p<0.05), as well as high NO production at the beginning of the M protocol, assessed by the L-Arg/ADMA ratio (88.6±11.6ng/ml vs. 41.7±6.4ng/ml, respectively, p<0.05) were observed. Moreover, increase in the PAI-1 level during the therapy was associated with smaller risk for poor outcome.Conclusions: Increased lipid peroxidation, low E-selectin at baseline, as well as increased NO bioavailability, decreased PAI-1 levels at the beginning of the M protocol are common feature in children classified to the high risk group. Low NO bioavailability at baseline and high at the beginning of the M protocol as well as decreased anti-inflammatory and antiaggregatory function of endothelium at the beginning of the M protocol are associated with higher risk for poor prognosis. Disclosures:No relevant conflicts of interest to declare.

Reactive Hyperemia Index and Detection of Endothelial Dysfunction in High Risk Children

Objective: To evaluate Reactive Hyperemic Index (RHI) as an indicator of endothelial function (EF) in children with type 1 diabetes mellitus (T1DM) and in children following treatment for acute lymphoblastic leukemia (ALL) in comparison with healthy controls (HC). RHI was further correlated with anthropometric and biochemical parameters. Research design and Methods: 54 eligible study participants were enrolled in the study (14 T1DM (16±2.2yrs) and 28 ALL patients (14±3.4yrs) matched with 12 HC (16±1,7yrs)). As part of new non-invasive plethysmographic technique, an Endo-PAT2000® recorder was used for the determination of RHI by measuring postocclusive endothelium-dependent changes in vascular tone (PAT) in subjects fingertips. Results: Significantly lower RHI were revealed in T1DM and ALL patients in comparison with HC (1.50±0.56, 1,57±0.50 and 1.96±0.62; p≤ 0.05 respectively), implying impaired endothelial-dependent dilation. No association was revealed between RHI and anthropometric parameters, arterial blood pressure or glycated haemoglobin in both T1DM and ALL groups. Conclusion: Detection of endothelial dysfunction using RHI in T1DM children is in concordance with results of previously published studies. Low RHI in ALL children supports our hypothesis of endothelial dysfunction in this group. Our study demonstrated that a non-invasive method such as RHI is a promising future prospect for the assessment of EF in children with high risk of premature atherosclerosis. This work was supported by the Charles University Student Research Project SVV-2010-260805

Lack of relationship between sedentary behaviour and vascular function in children

Some evidence suggests that sedentary behaviour is independently associated with cardiovascular (CV) risk. Endothelial dysfunction is the earliest detectable manifestation of CVD and a strong independent predictor of CV events. No previous study has examined the relationship between sedentary behaviour and endothelial function. We assessed the basal association between conduit artery endothelial function and sedentary behaviour in children, along with the correlation between changes in sedentary behaviour and endothelial function. We studied 116 children (70♀: 10.7 ± 0.3; 46♂: 10.7 ± 0.3 years) on two occasions; in the summer (June) and late autumn (November). We assessed endothelial function via flow-mediated dilation (FMD) using high-resolution Doppler ultrasound. Sedentary behaviour (SB) was assessed using objective uni-axial accelerometry. At baseline, there were no significant differences between girls and boys for any measured variables with the exception of total physical activity time. FMD was not associated with sedentary behaviour in either group or in the cohort as a whole. Although FMD decreased (10.0 ± 4.3-7.9 ± 3.9%, P < 0.001) and SB increased (499.1 ± 103.5-559 ± 81.6 min/day, P < 0.001) between the seasons, no relationship existed between changes in these variables. Our data suggest that sedentary behaviour and changes in sedentary behaviour are not associated with endothelial function in children.

Platelet reactivity and endothelial function in children of patients with early acute myocardial infarction

To assess whether platelet reactivity is increased in offspring of patients with early acute myocardial infarction (AMI) and its possible relation with endothelial dysfunction. We studied 23 healthy children (15±3 years, 13 males) of patients with early AMI (≤50 years old; Group 1) and 21 healthy children of healthy subjects without any history of cardiovascular disease (14±3 years, 10 males; Group 2). Platelet reactivity was assessed by flow cytometry as the increase in monocyte-platelet aggregates (MPA) and CD41 and PAC-1 platelet expression in response to exercise stress test (EST), adenosine diphosphate (ADP) stimulation (10(-7) M), or both. Endothelial function was assessed by measuring brachial artery dilation during post-ischaemic forearm hyperaemia [flow-mediated dilation (FMD)]. Both EST and ADP induced a higher percentage increase in platelet receptor expression in Group 1, compared with Group 2, with the most significant difference being shown for the response to the combined stimuli (e.g. MPA, 23.1±12 vs. 5.63±8%, P<0.001; platelet PAC-1, 57.7±47 vs. 13.2±7%, P<0.001). Compared with Group 2, Group 1 children showed lower FMD (10.7±3.1 vs. 8.0±2.9%, respectively; P=0.007). However, no significant association was found between FMD and platelet reactivity. Our results show increased platelet reactivity in children of patients with early AMI; the finding was not significantly correlated with endothelial dysfunction, suggesting that other mechanisms are mainly involved in the enhanced platelet response to agonistic stimuli.

Endothelial function in children and adolescents with mucopolysaccharidosis

Endothelial function in children and adolescents with mucopolysaccharidosis

HMG CoA reductase inhibition and endothelial function in children with chronic kidney disease (CKD) – a pilot study

HMG CoA reductase inhibition and endothelial function in children with chronic kidney disease (CKD) – a pilot study

Prevalence of risk factors for cardiovascular disease and their relationship with waist circumference in healthy, young adults

Background: Cardiovascular disease (CVD) is the primary cause of mortality in the UK and body fat is one of the main modifiable risk factors which predisposes individuals to CVD (Grundy et al., 1999). However few studies have focused on assessing risk markers in younger adults. The aim of this study was to determine body composition and associated risk factors for CVD in a randomly selected sample of healthy young adults.Methods: One hundred and twelve self‐reported healthy men and women aged 20–40 years were recruited to the study. Body composition was measured using body mass index (BMI), waist circumference (WC), waist‐to‐height ratio (WHTR), sum of skinfolds, and percentage body fat (%BF) as measured by air displacement plethysmography (using BodPod®, Life Measurement Inc., Concord, CA, USA), dual energy X‐ray absorptiometry (DXA), and bioelectrical impedance analysis (using prediction equations from Tanita®, Tanita UK Ltd, Yiewsley, Middlesex, UK). A fasting blood sample was collected and lipid profiles and high sensitivity C‐reactive protein (hs‐CRP) concentration were measured using commercially available kits (Instrumentation Laboratory) on the ILab 600 Chemistry Systems autoanalyser. Independent samples t test (or Mann–Whitney U‐test, where appropriate) and correlation analysis were performed. Results for male and female subjects, and according to Waist Action Level 1 (WAL 1) Anthropometry Male (n = 55) Female (n = 57) &lt;WAL 1 (n = 58) &gt;WAL 1 (n = 54)‡ &amp; Biochemistry Mean SD Mean SD Mean SD Mean SD BMI (kg m−2) 27.13 3.81 25.61 5.15 23.55 2.68 29.38*** 4.29 WC (cm) 91.67 9.58 83.66*** 12.27 – – – – WHTR 0.52 0.06 0.50 0.07 – – – Sum of skinfolds 5.78 2.33 7.41** 3.38 5.21 2.21 8.12*** 3.05 BodPod® (% BF) 22.65 8.85 32.86*** 9.44 21.13 7.37 35.06*** 8.26 DXA (% BF) 24.84 7.63 36.57*** 8.02 25.22 7.92 36.81*** 7.86 Tanita® (% BF)† 22.54 6.09 32.36*** 8.26 22.12 5.85 33.55*** 7.46 TC (mmol/l) 4.78 1.09 4.53 0.97 4.44 0.94 4.89* 1.08 HDL‐C (mmol L−1) 1.25 0.33 1.47*** 0.3 1.45 0.35 1.26** 0.28 LDL‐C (mmol L−1) 2.98 0.93 2.59* 0.89 2.57 0.84 3.01* 0.96 LDL‐C: HDL‐C ratio 2.53 1.03 1.84*** 0.74 1.87 0.76 2.51*** 1.04 Triacylglycerol (mmol L−1) 1.22 0.68 1.05 0.48 0.92 0.37 1.37*** 0.69 hs‐CRP (mg L−1)‡ 0.90 1.66 1.20* 2.35 0.90 1.57 1.40* 2.42 Age‐adjusted correlation analysis of the relationship between mean WC and biochemical CVD risk factors Correlation variable R value P value TC (mmol L−1) 0.110 0.250 LDL‐C (mmol L−1) 0.187* 0.050 HDL‐C (mmol L−1) −0.446*** &lt;0.000 LDL‐C:HDL‐C ratio 0.393*** &lt;0.000 Triacylglycerol (mmol L−1) 0.357*** &lt;0.000 hs‐CRP (mg L−1)†† 0.167 0.079 Values presented as mean and standard deviation; WAL 1: WC of 94cm (male) or 80cm (female); Mean values significantly different from the male subjects/&lt;WAL 1 group: *P ≤ 0.05, **P ≤ 0.01, ***P ≤ 0.001. ‡There was no significant difference in age between the WAL groups; † Male: n = 53 due to an incomplete data set. ††Median values used (Mann–Whitney U‐test). Discussion: The concentration of the inflammatory marker, CRP, was higher in women, an observation which has recently been reported in adolescent girls (Mackenzie et al., 2008). Greater central abdominal obesity, as assessed by higher WC, was associated with biochemical risk factors for CVD, such as lipid profile and CRP, suggesting that WC may act as a time and cost effective surrogate marker of inflammation and hyperlipidaemia in young asymptomatic adults, a finding in keeping with earlier research (Shen et al., 2006).Conclusions: In younger healthy adults, gender, age and central obesity impact on biochemical markers established as independent risk factors for CVD, such factors can be easily assessed in the clinical setting and appear useful in identifying young adults at risk of CVD.References Grundy, S.M., Pasternak, R., Greenland, P., Smith, S. &amp; Fuster, V. (1999) Assessment of cardiovascular risk by use of multiple‐risk‐factor assessment equations: a statement for healthcare professionals from the American Heart Association and the American College of Cardiology. J. Am. Coll. Cardiol.34, 1348–1359.Mackenzie, K.E., Wiltshire, E.J., Peña, A.S., Gent, R., Hirte, C., Piotto, L. &amp; Couper, J.J. (2008) Hs‐CRP is associated with weight, BMI, and female sex but not with endothelial function in children with type 1 diabetes. Pediatr. Diabetes10, 44–51.Shen, W., Punyanitya, M., Chen, J., Gallagher, D., Albu, J., Pi‐Sunyer, X., Lewis, C.E., Grunfeld, C., Heshka, S. &amp; Heymsfield, S.B. (2006) Waist circumference correlates with metabolic syndrome indicators better than percentage fat. Obesity14, 727–736.

Pediatric Atorvastatin in Diabetes Trial (PADIT): A Pilot Study to Determine the Effect of Atorvastatin on Arterial Stiffness and Endothelial Function in Children with Type 1 Diabetes Mellitus

Fifty-one children with type 1 diabetes mellitus (DM1) participated in a double blinded, randomized, cross-over pilot study to determine whether 12 weeks of daily atorvastatin (20 mg daily) would reduce arterial stiffness and improve endothelial function. Secondary analysis demonstrated potential reduction of arterial stiffness following atorvastatin therapy (p = 0.06). Additional long-term prospective studies with larger numbers of patients are needed.

Doppler assessment of brachial artery flow as a measure of endothelial dysfunction in pediatric chronic renal failure

Cardiovascular morbidity and mortality are highly prevalent among patients with chronic renal failure (CRF). Endothelial dysfunction is regarded as the initial reversible step in the development of atherosclerosis and has been demonstrated in all stages of renal failure. Non-invasive techniques to assess endothelial function have been recently developed and have been proven to predict future mortality in adults. We aimed to assess endothelial function in children with stage 4 chronic kidney disease (CKD 4) on conservative treatment, using a-non invasive, high-resolution, ultrasound Doppler study of the brachial artery flow, correlating it with other clinical and laboratory parameters. This study included 34 children with CKD 4 on conservative treatment who were compared with 30 healthy controls. Flow-mediated dilatation (FMD), nitroglycerin-mediated dilatation (NTG-MD) and FMD/NTG-MD ratio were estimated. FMD was abnormal (< 5%) in 24 patients (71%). FMD and FMD/NTG-MD ratio were significantly lower in patients than in controls (P = 0.001 and P = 0.01, respectively). FMD correlated positively with serum calcium and negatively with alkaline phosphatase. We concluded that endothelial dysfunction is present in children with CKD 4 on conservative treatment and may reflect increased atherogenic and thrombogenic properties of the endothelium, contributing to subsequent adverse cardiovascular outcome.

Intrauterine programming of the cardiovascular system

Intrauterine programming of the cardiovascular system

Endothelial function in children with a history of premature prolonged rupture of membranes and bronchopulmonary dysplasia – a pilot study

To investigate vascular function in children with a neonatal history of generalised inflammation indicated by premature prolonged rupture of membranes (PPROM) and bronchopulmonary dysplasia (BPD). Children born at <or=30 weeks 1994-2000 were investigated at a present age of 6-12 years. Twenty-eight children participated and were divided into two groups with regard to BPD/no BPD (n=15/13) and PPROM/no PPROM (n=10/18). Vascular endothelial function was assessed by acetylcholine (ACh)-induced skin vasodilatation. Maximum ACh-induced skin perfusion was statistically significantly lower in the PPROM group compared with the non-PPROM group (p=0.045) after adjustment for confounders. We found no association between BPD and maximum ACh-induced skin perfusion (p=0.404), after adjustment for confounders. A neonatal history of prolonged premature rupture of membranes was associated with later impairment of vascular endothelial function in childhood. This association was not observed with BPD. Some forms of perinatal inflammation may be associated with later cardiovascular function.