Abstract 3841: Noninvasive Measures of Subclinical Atherosclerosis in Children, A Systematic Overview
Background and objectives: In post-mortem studies, atherosclerotic changes are noted in children and adolescents and their extent is related to cardiovascular (CV) risk factors. Measurements of the carotid artery intimamedia thickness (cIMT), and brachial or femoral artery flow-mediated dilation (FMD) are non-invasive measures of subclinical atherosclerosis, which evaluate vascular structure and endothelial function. We evaluated the published experience of the measurement of subclinical atherosclerosis in children with conventional CV risk factors and aimed to quantitate abnormalities or severity of subclinical atherosclerosis in various risk subsets.
Methods and results: We performed a systematic overview of all studies examining cIMT and FMD in subjects aged ≤ 18 years published before Feb 2006. The studies were identified by a computerized search using Medline, Embase, The Cochrane Database of Systematic Reviews, The Cochrane Central Register of Control Trials (CCTR), and bibliographies of papers subsequently retrieved from the search. Twenty-six studies were included involving a total of 3630 subjects aged 5 – 18 years (21–471 subjects /study). One randomized controlled trial in familial hypercholesterolemia was identified showing decrease in cIMT with statin therapy for 2 years (p = 0.02). All the studies compared healthy controls with children with CV risk factors. Of the 15 studies that measured cIMT, 12 showed that cIMT was higher in the subgroups with risk factors (percent difference in mean cIMT was −2 to 32.6, mean 8.7 ± 7.8, p < 0.05). The 8 studies in which brachial or femoral artery FMD was measured, demonstrated reduced FMD among the high-risk groups (percent difference in mean FMD was 22.9 – 51.2, with average percent mean difference of 37 ± 12, p < 0.05).
Conclusions: Structural vascular abnormalities and endothelial dysfunction are present in children with risk factors for atherosclerosis. These studies suggest that primary prevention programs should be initiated in childhood.