Preclinical Aortic Atherosclerosis in Adolescents With Chronic Disease

Abstract

Background Adolescents with chronic disease are often exposed to inflammatory, metabolic, and hemodynamic risk factors for early atherosclerosis. Since postmortem studies have shown that atherogenesis starts in the aorta, the CDACD (Cardiovascular Disease in Adolescents with Chronic Disease) study investigated preclinical aortic atherosclerosis in these adolescents. Methods and Results The cross‐sectional CDACD study enrolled 114 adolescents 12 to 18 years old with chronic disorders including juvenile idiopathic arthritis, cystic fibrosis, obesity, corrected coarctation of the aorta, and healthy controls with a corrected atrial septal defect. Cardiovascular magnetic resonance was used to assess aortic pulse wave velocity and aortic wall thickness, as established aortic measures of preclinical atherosclerosis. Cardiovascular magnetic resonance showed a higher aortic pulse wave velocity, which reflects aortic stiffness, and higher aortic wall thickness in all adolescent chronic disease groups, compared with controls ( P <0.05). Age (β=0.253), heart rate (β=0.236), systolic blood pressure (β=−0.264), and diastolic blood pressure (β=0.365) were identified as significant predictors for aortic pulse wave velocity, using multivariable linear regression analysis. Aortic wall thickness was predicted by body mass index (β=0.248) and fasting glucose (β=0.242), next to aortic lumen area (β=0.340). Carotid intima‐media thickness was assessed using ultrasonography, and was only higher in adolescents with coarctation of the aorta, compared with controls ( P <0.001). Conclusions Adolescents with chronic disease showed enhanced aortic stiffness and wall thickness compared with controls. The enhanced aortic pulse wave velocity and aortic wall thickness in adolescents with chronic disease could indicate accelerated atherogenesis. Our findings underscore the importance of the aorta for assessment of early atherosclerosis, and the need for tailored cardiovascular follow‐up of children with chronic disease.

Enhanced aortic stiffness in adolescents with chronic disease is associated with decreased left ventricular global longitudinal strain

“…In the cross-sectional CDACD study, 114 adolescents aged 12–18 were prospectively enrolled between April 2017 and June 2019, as recently published [2] . The study population included patients with metabolic, inflammatory, and hemodynamic disorders: cystic fibrosis (CF, n = 24), corrected coarctation of the aorta (CoA, n = 25), rheumatoid factor negative polyarticular or extended oligoarticular juvenile idiopathic arthritis (JIA, n = 20), obesity (n = 20), and as a control group healthy adolescents with a corrected atrial septal defect (ASD), who showed normal cardiac dimensions and functions during follow-up (n = 25).…”

“…Waist and hip circumference were measured following established clinical standards [2] . Blood pressure was measured three times at the right arm after 10 min rest while seated.…”

“…CMR was performed on a Philips 3.0 Tesla CMR system, as reported previously [2] . In short, aortic PWV was assessed using 2D velocity-encoded CMR.…”

“…Children with chronic disease are frequently exposed to systemic inflammation, metabolic derangements, and hypertension, which can induce arterial changes [1] . The ‘Cardiovascular Disease in Adolescents with Chronic Disease’ (CDACD) study recently demonstrated a higher aortic wall thickness (AWT) and aortic pulse wave velocity (PWV), the latter of which reflects aortic wall stiffness, in adolescents with various chronic disorders, compared to controls [2] . The CDACD population included various chronic disease-associated risk factors for arterial changes, including metabolic risk factors in cystic fibrosis (CF) and obesity, inflammatory risk factors in juvenile idiopathic arthritis (JIA), and hypertension in corrected coarctation of the aorta (CoA).…”

Why and How Should We Assess the Cardiovascular Risk in Patients with Juvenile Idiopathic Arthritis? A Single-Centre Experience with Carotid Intima-Media Measurements

“…Nevertheless, there are conflicting data regarding the utilization of cIMT in the pediatric population. Ilisson et al [ 26 ] found increased cIMT in children at the early stage of JIA, whereas Mani et al [ 27 ] and Ververs et al [ 28 ] did not observe any significant difference between JIA patients and healthy controls. There are no data on cIMT values in healthy children depending on their attitude to the rules of cardiovascular prevention.…”