, et al
The relationship between coronary artery disease risk factors and carotid intima-media thickness in children
J Pediatr
; doi:

Investigators from multiple institutions conducted a cross-sectional study to assess the association between coronary artery disease risk factors and carotid intima-media thickness in children. Participants were fifth graders attending schools in southern Maine. For the study, families of participating children completed a questionnaire regarding history of early coronary vascular disease (CVD) in either parents or grandparents, and average physical activity in the child. The following data were collected on each study participant: height and weight (to calculate BMI), blood pressure (BP), total cholesterol, high-density lipoprotein cholesterol (HDL-C), and fasting glucose. Cut-off values were established to determine the presence of a coronary artery disease risk factor, including family history of early CVD (occurring at <55 years in male family members and <65 years in females), physical inactivity (<60 minutes/day), cholesterol (>170 mg/dL), HDL-C (<40 mg/dL), glucose (>100 mg/dL), overweight (BMI >85th percentile), and BP (>130/85). Ultrasound examinations of both the right and left carotid arteries were conducted in study children and carotid intima-media thickness measured. The association between the number of risk factors and carotid intima-media thickness was assessed with ANOVA. In addition, regression analysis was used to assess the association of individual risk factors with left and right average carotid intima-media thickness.

A total of 123 children were enrolled in the study. Results were obtained on 119 with a mean age of 10.5 + 0.52 years; 51% of participants were female. Overall, 65% of study children were overweight, 67% were physically inactive, 30% had high cholesterol levels, 25% low HDL-C, 13% high glucose levels, and 5% elevated BP. Compared to children with 0 coronary artery disease risk factors, those with 2 or 3 risk factors had significantly higher left carotid intima-media thickness (P<.001 for both), and those with 3 risk factors had significantly higher left and right average thickness (P<.03). There was no statistical association between risk factors and right carotid intima-media thickness. Among individual risk factors, high glucose levels, elevated systolic BP, and overweight were statistically associated with increased carotid intima-media thickness. In multiple analyses, overweight status was consistently the strongest variable associated with carotid intima-media thickness.

The authors conclude that the presence of 2 or more coronary artery disease risk factors is associated with carotid intima-media thickness.

Dr Doolittle has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

While tackling CVD risk factors is an important element of adult primary care, addressing these same issues among children is not often regarded as a priority. The results of the current study challenge us to reconsider and suggest that a more aggressive approach toward modifiable risk factors, even among children, may be important toward preventing future cardiovascular morbidity...

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