Childhood risk factors for adult cardiovascular disease and primary prevention in childhood

Abstract

A therosclerosis has been demonstrated in autopsy studies to have its origins in childhood. 1 In the young, there is a correlation between the intensity of exposure to risk factors such as cigarette smoking, hypertension, dyslipidaemia and diabetes mellitus and the extent and severity of arterial fatty streaks or raised plaques (fig 1).An important current trend that may increase the future burden of coronary heart disease (CHD) is a significant increase in the prevalence of childhood obesity. 2 In obesity, many of the risk factors for CHD are clustered together. Moreover, these risk factors usually persist or track into adulthood, so that their effect on the cardiovascular system may be present and influential for several decades.To reduce the future burden of CHD, we need to define prevention and intervention strategies that decrease the prevalence of cardiovascular risk factors in children and young adults and thereby hope to retard atherogenic processes. The purpose of this article is to review the evidence for the importance of the childhood risk factors for adult cardiovascular disease and to outline the evidence for the efficacy of primary prevention in young people. DETECTING EARLY ARTERIAL ABNORMALITIESc Studies on the impact of risk factors in childhood and on the effect of potentially beneficial interventions have been facilitated by the development of a number of non-invasive diagnostic techniques that can detect ''atherosclerosis'' at a preclinical stage (or at least the changes in arterial structure and/or function indicative of vascular damage). For example, the arterial endothelium plays a key role in atherogenesis, and clinical evaluation of the function of the endothelium is now possible through the assessment of nitric oxide-mediated vasodilatation produced by sheer stress (flow mediated dilatation (FMD)). FMD can be measured accurately and reproducibly by ultrasound. Impaired FMD has also been demonstrated in children at high risk of future CHD. 3 Measuring the velocity of the arterial pulse wave non-invasively might also be a valuable indicator of vascular ''stiffness'', and thus subsequent risk, in children.Intima media thickness (IMT), measured by ultrasound of the carotid arteries or aorta, is a structural change in the vasculature that also appears to have value as a surrogate marker of atherosclerosis. IMT is correlated with the number of cardiovascular risk factors present and it relates to the severity and extent of coronary artery disease. IMT predicts the likelihood of cardiovascular events in asymptomatic adults and increased IMT has also been demonstrated in children with known cardiovascular risk factors. 4 5 The number of risk factors present in males during late childhood and adolescence directly relates to the IMT in young adulthood, even after adjusting for contemporaneous risk factors. 5

Association of vitamin D insufficiency with adiposity and metabolic disorders in Brazilian adolescents

“…The inadequacy of the lipid profile observed in the present study has been described by the WHO as a problem in this age group in a number of countries (10) . It is noteworthy that the result showing the association of BMI with clinical and biochemical variables indicates the need for constant intervention with adolescents, thus reinforcing the importance of specific health care for this age group (37) . Several authors have discussed an extra-skeletal function of vitamin D and found that individuals with high levels of TC, LDL-C, insulin and blood pressure had serum 25(OH)D concentrations statistically lower than those with normal levels of these variables (6,7,35) .…”

Lack of relationship between sedentary behaviour and vascular function in children

“…In addition, interventions that improve endothelial function reduce cardiovascular mortality and morbidity (Chan et al 2003;Modena et al 2002). Impaired FMD is present in children and adolescents with CV risk factors such as cigarette smoking, hyperlipidemia, diabetes and hypertension (Celemajer and Ayer 2006) and obesity (Watts et al 2004a;Woo et al 2004). It has therefore been proposed that FMD represents a sentinel atherosclerotic event, which may reflect detrimental changes occurring in the vascular wall.…”

Obesity in the Childhood: A Link to Adult Hypertension

“…Of note, BMI measured in childhood is significantly associated with carotid intima-media thickness, measured in adulthood [74]. These aspects have been recently put in evidence by a recent Celermajer's editorial [75], in which it was also underlined that, since obese children and adolescents are likely to become obese adults, it is mandatory to prevent the childhood obesity in order to avoid the dramatic and too late association between adult obesity and coronary heart disease. In line with this concept, an interesting finding from the Bogalusa Heart Study demonstrated that the intima-media thickness was greater only in obese young adults who had been obese children, and not in obese children who become normal weight adults nor in thin children who become obese adults.…”