Increased intima-media thickness of the common carotid artery in hypercholesterolemic children.

Abstract

Common carotid intima-media thickness was measured by B-mode ultrasound imaging in 46 children (mean age, 7.4 years) with serum cholesterol 26.4 mmol/L (mean, 8.25 mmol/L) and in 48 children (mean age, 6.4 years) with serum cholesterol <6.4 mmol/L (mean, 4.60 mmol/L). Maximum thickness was significantly higher in hypercholesterolemic children than in control children (0.50 versus 0.47 mm, P=.007). Subgroup analysis showed that only in children >6.2 years old (the median of all the children's ages) was maximum thickness significantly higher in hypercholesterolemic children than in control children (0.51 versus 0.48 mm, P=.O14). The odds ratio (OR) of common carotid intima-media thickening T he relationship between hypercholesterolemia and coronary artery diseases (CAD) has been proved in adult CAD patients. 1 " 3 The significance of this relationship is more controversial in healthy subjects, particularly if their serum cholesterol is <6.4 mmol/L, 4 -6 Children form a special subgroup of healthy individuals.Population-based or "high-risk"-based screenings for serum cholesterol are usually recommended, 710 although others oppose this view on the basis of potential harm and of nonproven efficacy in the prevention of adult CAD. 1112Autopsy studies on arterial specimens of human subjects have shown that fatty streaks (nonraised lesions) can be found in the aortas even of 3-year-olds 13 and appear in the coronary arteries during the second decade of life.14 More advanced coronary atherosclerosis was seen in a majority of young adults in whom autopsies were performed during the Korean and Vietnam wars. -16 Aortic fatty streaks detected in subjects who had died between full-term birth and age 29 years appeared to be strongly related to antemortem levels of both total and low-density lipoprotein (LDL) cholesterol. 17 Raised lesions, like fibrous plaques, are related to clinical CAD, 18 but the progression of fatty streaks to fibrous plaques is uncertain. Arterial fibrous plaques have been found in autopsy specimens from children, Received October 5, 1993; revision accepted March 25, 1994. From the Institute of Internal Medicine and Metabolic Diseases and the Department of Pediatrics (R.S., A. Di C), Federico II University, Naples, Italy.Correspondence to Dr Paolo Pauciullo, Institute of Internal Medicine and Metabolic Diseases, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy.© 1994 American Heart Association, Inc.(maximum thickness of the far wall higher than the 95th percentile of the control group, 0.51 mm) between patients and control subjects was statistically significant both in univariate analysis (OR, 6.39; 95% confidence interval, 1.19 to 32.3; f>=.025) and after age (OR, 5.96; 95% confidence interval, 1.09 to 32.4; P=.O39) and sex (OR, 7.54; 95% confidence interval, 1.38 to 41.2; P=.02O) were controlled for. Children >6 years old with serum cholesterol ^6.4 mmol/L show increased thickness of the common carotid intima-media.

Elevated Blood Pressure in Offspring Born Premature to Hypertensive Pregnancy

“…Carotid wall thickening has been demonstrated previously in children and adults with cardiovascular risk factors, such as smoking 48,49 and hypercholesterolemia. 50,51 We were, therefore, interested to know whether, similar to the Figure.…”

Carotid Intimal-Medial Thickness and Stiffness Are Not Affected by Hypercholesterolemia in Uncomplicated Essential Hypertension

“…In addition, studies conducted in normotensive children with familial hypercholesterolemia and very high cholesterol levels showed only modest associations between carotid IMT and cholesterol levels. 43,44 Although it is unclear whether it is more clinically and prognostically meaningful to exclude from the calculation of IMT all discrete areas of wall thickening, measurements performed in arterial segments including discrete plaques could overemphasize the association between risk factors for atherosclerotic disease and the IMT of representative segments of the arterial tree. Data from our study suggest that when IMT is measured in areas free of discrete atherosclerotic lesions, common carotid wall thickness in hypertensive patients is not strongly affected by mild to moderate hypercholesterolemia.…”

“…This concept is in agreement with observations that normotensive hypercholesterolemic children had mean wall thicknesses similar to those of normocholesterolemic controls, whereas the maximum IMT was significantly higher in the hypercholesterolemic group. 43 A potential limitation of ultrasonographic evaluation of the arterial intimal-medial complex is that it does not allow separation of increased medial mass due to hypertrophy from increased intimal mass due to atherosclerosis and arteriosclerosis. Therefore, early atherosclerotic lesions involving only the intimal layer may cause only small increases in the composite wall thickness measured by vascular ultrasonography that might be confused with medial hypertrophy in the presence of hypertension.…”

Carotid artery wall hypertrophy in children with metabolic syndrome

“…7 An increase in carotid IMT has been observed in children with known metabolic risk factors, that is hypercholesterolemia, diabetes mellitus and obesity. [8][9][10][11] The cross-sectional area of the intima-media complex (CSA-IMC) has been found to be a good indicator of arterial wall mass, closely related to cardiac left ventricular mass, and has been demonstrated to be another accurate predictor of coronary atherosclerosis. 12,13 Risk factors for cardiovascular disease frequently cluster within individuals in both children and adults.…”