Cardiovascular risk assessment is an accepted practice in adults and correlates with early changes in carotid structure and function. Its clinical use in pediatrics is less common. We sought to determine whether a simple method of clustering cardiovascular risks could detect early atherosclerotic changes in youth. In addition, we compared risk clustering with the accepted Patholobiological Determinants of Atherosclerosis in Youth score to assess its utility for predicting early vascular disease.
We collected demographic, anthropometric, laboratory, and vascular measures in a cross-sectional study. The study population (n = 474; mean age: 18 years) was divided into low-risk (0–1) or high-risk (≥2) groups on the basis of the number of cardiovascular risk factors present at evaluation. Group differences and vascular outcomes were compared. General linear models were used to compare clustering cardiovascular risks with the Patholobiological Determinants of Atherosclerosis in Youth score.
The high-risk group had higher vascular thickness and stiffness compared with the low-risk group (P < .05). Regression models found that clustering cardiovascular risks is associated with abnormal vascular structure and function after adjustment for age, race, and gender. The Patholobiological Determinants of Atherosclerosis in Youth score also is associated with abnormal vascular structure and function but with lower R2 values (P < .05).
Cardiovascular risk clustering is a reliable tool for assessing abnormal vascular function. Its simplicity, compared with the Patholobiological Determinants of Atherosclerosis in Youth score, provides an advantageous tool for the practicing clinician to identify those youth who are at higher risk for early cardiovascular disease.
Authors:
I am confused about two seemingly conflicting findings in your study. In the first paragraph of the Results section, you state that the high- risk group had significantly thicker and stiffer vessels compared with the low-risk group... Then, on page e317, of the discussion section, last paragraph before the conclusion, you state "Second, we found that in youth with 2 or more cardiovascular risk factors, higher carotid vascular thickness and stiffness compared with those with 0 to 1 risk factor." I am interested in the concept of clustering of risk factors, and think it is valuable when assessing CVD risk, but how do these findings, as stated, support such practice?
Second, you say that assessment of cardiovascular risk factors is not used in pediatrics. The AAP published a clinical report for lipid screening guidelines in 2008, revising previous guidelines. These aim to help determine the need for lipid screening, as part of CV assessment, and thus CVD risk.
Conflict of Interest:
None declared