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

Abstract

Abstract-The rapid increase in the prevalence and severity of obesity in children is likely to lower the age of onset and increase the incidence of cardiovascular disease worldwide. Understanding the pathophysiology and improving the clinical management of cardiovascular disease involve a knowledge of novel risk factors and biomarkers. The clinical and mechanistic roles of these novel biological factors during childhood are currently being investigated. The goals of this scientific statement are to present the existing knowledge and theoretical framework of nontraditional risk factors for cardiovascular disease as they relate to children and adolescents, to describe the relevance and weight of available experimental and clinical evidence and the therapeutic implications pertaining to nontraditional risk factors in the pediatric population, and to stimulate further research with a goal of developing valid and reliable approaches to identify and validate novel risk factors that will aid in the clinical evaluation and perhaps prediction of cardiovascular disease in the pediatric population. Although several biomarkers are promising, substantial research is required before nontraditional risk factors can be used to identify and reduce cardiovascular disease risk in children and adolescents. (Circulation. 2011;123:2749-2769.)

Size and phospholipid coating of lipid droplets in the diet of young mice modify body fat accumulation in adulthood

“…Given that systemic adipokine levels were not significantly perturbed by the moderate WSD challenge as compared with normal rodent chow, the limited improvement in adult adipokine profile due to Concept IMF was to be expected. However, lower plasma leptin and resistin in the Concept IMF group suggest an improved metabolic profile as compared with Control IMF given that leptin is correlated with FM, resistin is associated with insulin resistance, and both are increased in obese adolescent subjects (46).…”

Prevalence of Cardiovascular Disease Risk Factors among Scottish Youth: A Pilot Investigation

“…Elevated levels of PAI-1, IL-6 and low levels of adiponectin are independent predictors of type 2 diabetes in adolescence and CVD related events in adulthood (Balagopal et al, 2011;Tam et al, 2010). Data for the prevalence of these biomarkers in UK South Asian populations are limited and as such, it is difficult to evaluate our observations.…”

“…This may reflect a trend noted among European adults of South Asian ancestry who tend to have lower levels of total cholesterol and LDL than White Europeans (Cappuccio et al, 1997). Elevated levels of CRP are strongly associated with insulin resistance and risk of type 2 diabetes among adolescents (Balagopal et al, 2011;Tam et al, 2010). South Asian boys had significantly greater levels of CRP than girls (Table 2) and just less than one-half of the boys and girls had CRP levels considered at risk (Table 3).…”

Reproducibility of Circulating Endothelial Cell Enumeration and Activation in Children and Adolescents

“…Examining early perturbations in the vascular endothelium may provide clinicians and researchers with better biomarkers of subclinical cardiovascular disease (CVD) risk, especially in pediatric populations where clinically useful biomarkers are lacking [2]. Circulating endothelial cells (CEC) may be one such biomarker since they are thought to reflect structural damage and injury to the endothelial monolayer [3].…”

“…In order for biomarkers to be deemed as having clinical utility and worthy of measurement in the research setting they must be reproducible, be proximal to the pathogenesis of a disease, provide prognostic value beyond currently established risk factors and biomarkers and be predictive of disease outcome [2,6].…”