Systemic Inflammation, Oxidative Stress and Cardiovascular Health in Children and Adolescents: A Systematic Review

Abstract

Recent studies indicate that cerebrovascular diseases and processes of atherosclerosis originate in the childhood era and are largely influenced by chronic inflammation. Some features of vascular dysfunction in adulthood may even be programmed prenatally via genetic influences and an unfavorable intrauterine milieu. Oxidative stress, defined by an imbalance between the production and generation of reactive oxygen species (ROS) in cells and tissues and the capability of an organism to scavenge these molecules via antioxidant mechanisms, has been linked to adverse cardiovascular health in adults, yet has not been systematically reviewed in the pediatric population. We performed a systematic search as per the PRISMA guidelines in PubMed/Medline and Cochrane Reviews and detected, in total, 1228 potentially eligible pediatric articles on systemic inflammation, oxidative stress, antioxidant use, cardiovascular disease and endothelial dysfunction. The abstracts and full-text manuscripts of these were screened for inclusion and exclusion criteria, and a total of 160 articles were included. The results indicate that systemic inflammation and oxidative stress influence cardiovascular health in many chronic pediatric conditions, including hypertension, obesity, diabetes mellitus types 1 and 2, chronic kidney disease, hyperlipidemia and obstructive sleep apnea. Exercise and diet may diminish ROS formation and enhance the total serum antioxidant capacity. Antioxidant supplementation may, in selected conditions, contribute to the diminution of the oxidative state and improve endothelial function; yet, in many areas, studies provide unsatisfactory results.

Oxidative Stress Parameters as Biomarkers of Cardiovascular Disease towards the Development and Progression

“…In FH patients, oxidative stress is a major factor in the onset and development of atherosclerosis. It is reported that hypercholesterolemia causes the production of superoxide radicals, which inhibits the activity of endothelial nitric oxide synthase (eNOS), lowering NO bioavailability as an antioxidant resulting in an inflammatory response in the artery wall [ 57 , 58 ].…”

Determination of salivary concentrations of leptin and adiponectin, ability to reduce ferric ions and total antioxidant capacity of saliva in patients with severe early childhood caries

“…Caries is characterized by the same etiological factors that lead to other chronic non-communicable diseases that are associated with increased dietary sugar intake, such as cardiovascular disease, diabetes, and obesity. There is strong evidence that there is a link between oral diseases and chronic systemic disorders ( 33 , 34 ). Although numerous studies have looked into the links between chronic systemic and dental conditions, it is still unclear how this information can be applied in clinical practice, particularly when it comes to pediatric patients ( 41 – 43 ).…”

“…The rationale was that dental caries could increase the risk of systemic inflammation in a variety of ways ( 33 ). For example, among hypertensive pediatric patients with poor oral status, the intensive oxidation of several plasma substrates, increase in reactive metabolites of oxygen, lipid peroxidation, inactivation of prostacyclin and nitric oxide and an imbalance in the total antioxidant capacity were noted ( 34 – 36 ).…”

Role of reactive oxygen species in regulating 27-hydroxycholesterol-induced apoptosis of hematopoietic progenitor cells and myeloid cell lines

“…Nearly 50 % of all heart attacks and strokes occur in patients with normal cholesterol levels [ 9 ]. Furthermore, oxidative stress and micro-inflammation are more complex and intimately linked with cardiovascular disease [ 10 ].…”