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Target Organ Damage in Youth with Cardiovascular Risk Factors – It Begins in Adolescence

May 4, 2022

Editor’s Note: Jenny Zhang is a second-year pediatrics resident at the University of Virginia. Her interests include all things related to cardiology, hepatology, or immunology. She is planning to pursue a career in pediatric cardiology.

-Rachel Y Moon, Associate Editor, Digital Media, Pediatrics

As part of my counseling with patients, I emphasize the importance of a diversified diet and routine physical activity in order to prevent the development of target organ damage from the effects of cardiovascular disease, hypertension, or diabetes. Unfortunately, that organ damage may have already begun.

Many children with the core elements related to metabolic syndrome (obesity, hypertriglyceridemia, hypertension, and elevated fasting blood glucose) tend to appear healthy. There are also low rates of overt cardiovascular disease in children. Therefore, until now, little attention has been paid to the burden of disease in youth with cardiovascular risk factors.

In a pioneering study from Dr. Joshua Price and colleagues from the University of Washington and 5 other institutions that is being early released in Pediatrics this week, the authors analyzed data from the Study of High Blood Pressure in Pediatrics, Adult Hypertension Onset in Youth (SHIP AHOY) study to identify the prevalence of subclinical target organ damage in youth with cardiovascular risk factors (10.1542/peds.2021-054201). The SHIP AHOY study is one of the largest and most comprehensive evaluations of cardiovascular risk factors in youth to date.

The study group included otherwise healthy children aged 11-18 years with blood pressures in the 75-95th percentile. The authors measured several markers of target organ damage, such as left ventricular cardiac mass, pulse wave velocity (a measure of stiffness of the blood vessel walls), and urine albumin/creatinine ratio (a measure of kidney damage). They then also tallied cardiovascular risk factors, which included abnormal blood pressure, elevated body mass index, high lipid levels, and insulin resistance, to look for associations with target organ damage.

The authors found that the more cardiovascular risk factors a child had, the more likely they were to have markers of target organ damage. Interestingly, additional multivariable models demonstrated independent associations between specific cardiovascular risk factors and specific markers of end organ damage. You should read the entire article for additional details, but one example is that increased blood pressure was associated with all markers of cardiac damage.

This study demonstrated that even healthy appearing adolescents without chronic illnesses or overt cardiovascular disease but with known risk factors, particularly blood pressure abnormalities, have signs of early target organ damage. Will you be more aggressive with your screening and lifestyle interventions following this study? You will want to read the article and view the video abstract to find out more.

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