Determinants of haemostatic risk factors for coronary heart disease in obese children and adolescents

Abstract

OBJECTIVE: To investigate the contribution of serum lipids, parameters of glucose metabolism, body composition and cardiovascular ®tness to the variance of several haemostatic risk factors for coronary heart disease (CHD) in obese children and adolescents. SUBJECTS AND MEASUREMENTS: Forty-two healthy, obese children and adolescents (20 male, 22 female, age 12.6 AE 3.2 y; body mass index (BMI), 30.4 AE 5.3 kgam 2 ), were screened for haemostatic and metabolic risk factors for CHD. Thirty-®ve of the participants (18 male, age 13.5 AE 2.9 y; BMI, 29.9 AE 4.5 kgam 2 ; 17 female, age 12.8 AE 2.1 y, BMI, 31.1 AE 5.3 kgam 2 ) were assessed for cardiovascular ®tness by means of incremental cycle ergometer exercise. RESULTS: After adjustment for age, fat mass correlated signi®cantly with plasminogen activator inhibitor-1 antigen (PAI-1-Ag) in boys and girls and factor VIIc only in girls. Children with lower power output ( 2.77 Wakg) showed signi®cantly higher values for factor VIIc, ®brinogen and tissue-type plasminogen activator antigen (tPA-Ag). Neither body composition nor cardiovascular ®tness contributed independently to the variance of the determined haemostatic risk factors, except PAI-1-Ag, which has been shown to be determined by fat mass. In multiple linear regression analysis, triglycerides and PAI-1-Ag explained signi®cant independent proportions of the variance of tPA-Ag. Factor VIIc was explained by C-peptide, insulin and ®brinogen. Von Willebrand factor antigen (vWF-Ag) was signi®cantly related to glucose and insulin. CONCLUSION: The results suggest that in obese children and adolescents the haemostatic risk factors factor VIIc, vWF-Ag and tPA-Ag are mainly determinated by plasma insulin and triglyceride concentrations, but are primarily independent of body composition and cardiovascular ®tness.

Insulin resistance is associated with at least threefold increased risk for prothrombotic state in severely obese youngsters

“…By serving as a carrier for factor VIII, vWF-Ag may coordinate formation of the fibrin-and platelet-rich thrombus at the site of endothelial cell injury as well [39]. There have been studies that reported increased levels of vWF-Ag in the CI confidence interval, FB fibrinogen, IR insulin-resistant, NIR non insulin-resistant, OR odds ratio, PAI-1 plasminogen activator inhibitor-1-antigen, vWF-Ag von Willebrand factor-antigen obese pediatric population and significant positive associations between vWF-Ag levels and the BMI [26,62]. In the present study, insulin resistance was found to increase the possibility of detecting abnormally high vWF-Ag levels by 4.8 times.…”

Nontraditional Risk Factors and Biomarkers for Cardiovascular Disease: Mechanistic, Research, and Clinical Considerations for Youth

“…87 Studies in children and adolescents have demonstrated a close relationship between fibrinogen, obesity, and physical fitness 88 -90,118,119,231,233 ; this in turn is implicated in cardiovascular morbidity and mortality later in life. 80,91 The underlying pathophysiological mechanisms for these alterations, however, remain elusive. Studies in children have reported that the increased plasma fibrinogen is due primarily to an increase in its fractional synthesis rate, 119,120 a phenomenon that does not occur in the elderly.…”

Effects of exercise on leukocytosis and blood hemostasis in 800 healthy young females and males

“…In this regard, elevated plasma concentrations of von Willebrand factor, t-PA and PAI-1 could be predictors of myocardial infarction and stroke incidence in older or in cardiac patients [28] . However, fibrinolysis is increased during 2 h triathlon where it neutralizes the increase in thrombin generation [29] , and increased D-dimer activity in healthy individuals is a marker of hydrolyzing the cross-linked fibrin by plasminogen which is generated from plasmin by t-PA.…”