AHA 2008: ‘Vascular age’ of obese children similar to that of middle-aged men

November 12, 2008

New Orleans-Obese children, particularly those with elevated triglycerides, have a “vascular age” similar to those of 45-year-old white men, says Geetha Raghuveer, MD, University of Missouri-Kansas City School of Medicine. “I think this is a wake up call,” she says. “These children may need intensive management including pharmacological management of risk factors.

New Orleans-Obese children, particularly those with elevated triglycerides, have a “vascular age” similar to those of 45-year-old white men, says Geetha Raghuveer, MD (pictured) University of Missouri-Kansas City School of Medicine. “I think this is a wake up call,” she says. “These children may need intensive management including pharmacological management of risk factors.

“Children do have some arterial wall changes related to risk factors. Willrisk factor modification improve these changes? We hope so. These children don’thave hard, calcified plaque like adults,” she explains. However, furtherstudies will be needed to assess the impact of risk factor alteration on vascularage in children.

Dr. Raghuveer measured carotid-intima-media thickness (CIMT) in 70 obese childrenwith a mean age of 13, mean weight of 64 kg, mean body mass index (BMI) of 25.6kg/m2, and a mean systolic blood pressure of 119.9 mm Hg. In this group therewere 59 children with total cholesterol levels >170 mg/dL, 51 had LDL levels>110 mg/dL, 17 had low HDL of less than 35, and 43 had triglyceride levelsover 100 mg/dL. Forty of the children had a BMI greater than the 95th percentilefor their age.

Mean CIMT was 0.45 mm
The mean CIMT was 0.45 mm, which equates to approximately that seen in the 25thpercentile of 45-year-old men. The maximum CIMT observed in these children was0.75 mm, which is equivalent to that observed in the 50th percentile of 65-year-oldmen or the 90th percentile of 45-year-old men, Dr. Raghuveer explains.

Elevated triglycerides were identified as the strongest predictor of increasedCIMT in these children. Dr. Raghuveer says that among 18 children with a vascularage below the 25th percentile of the group studied, only five had triglyceridelevels exceeding 100 mg/dL. However, of the 52 children with a vascular age abovethe 25th percentile, 38 had elevated triglycerides. American College of Cardiology/AmericanHeart Association guidelines state that triglycerides levels above 100 mg/dL contributeto cardiovascular disease development.

These results indicate that vascular age is advanced in children with risk factorssuch as obesity and dyslipidemia. Dr. Raghuveer suggests that for such children,carotid artery ultrasound may help stratify patients who may be at greatest riskfor heart disease.