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Modifiable Clinical Correlates of Vascular Health in Children and Adolescents with Dyslipidemia

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Abstract

Atherosclerosis promoting cardiovascular disease risk factors (CVDrf) are highly prevalent among youth in the U.S. Determining which standard modifiable clinical measures (SMCMs) has the greatest impact on vascular structure and function is valuable for the health care provider to help identify children at highest risk. The aim of this study was to determine modifiable outpatient clinical predictors of vascular health in youth with CVDrf. Children and adolescents with CVDrf (n = 120, 13.1 ± 1.9 years, 49% female) were recruited from a pediatric preventive cardiology clinic. The SMCMs included BMI z-score, waist-to-height ratio (WTHR), lipid panel, hemoglobin A1c, blood pressure (BP), presence of tobacco smoke exposure, and presence of hypertriglyceridemic waist (HTW) phenotype (triglycerides ≥ 110 mg/dL and waist circumference ≥ 90 percentile). Vascular function and structure were measured with pulse wave velocity (PWV), central systolic BP (CSP), augmentation index (AIx), and carotid artery intima-media thickness (cIMT). Sex and height specific z-scores for PWV, CSP, and cIMT were used. Multiple linear regression with backwards selection identified SMCMs which strongly predicted vascular function and structure. Among SMCMs, WTHR and HTW were the most frequent predictors of vascular function (PWV: R2 = 0.32; CSP: R2 = 0.35; AIx R2 = 0.13). Other predictors of vascular function included hemoglobin A1C, BP, and BMI z-score. Systolic BP and LDL cholesterol were predictors of vascular structure (cIMT: R2 = 0.14). The strongest predictors of vascular health in youth with CVDrf were related to measures of central obesity. Targeting these SMCM in lieu of vascular testing in outpatient clinic setting may be practical to identify children and adolescents at greatest risk for CVD.

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Abbreviations

AIx:

Augmentation index

BMI:

Body mass index

CVDrf:

Cardiovascular disease risk factors

cIMT:

Carotid artery intima-media thickness

CSP:

Central systolic pressure

HbA1c:

Hemoglobin A1c

HDL-C:

High density lipoprotein cholesterol

HTW:

Hypertriglyceridemic waist phenotype

LDL-C:

Low density lipoprotein cholesterol

PWV:

Pulse wave velocity

SMCM(s):

Standard modifiable clinical measures

WTHR:

Waist-to-height ratio

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Acknowledgements

Kathrine Berry Richardson Foundation internal research award from Children’s Mercy Hospital; and Sarah Morrison medical student research award from the University of Missouri Kansas City, School of Medicine funded this study. We would like to thank our patients who generously shared their time participating in this study.

Funding

This study was funded through an internal grant through The Children’s Mercy Hospital supported by the Katherine Berry Richardson Foundation. The study sponsor had no role in study design, data collection, data analysis, interpretation of the results, writing of the manuscript, decision to submit the manuscript, or journal choice.

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Authors and Affiliations

  1. The Ward Family Heart Center, Children’s Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, 64108, USA

    David A. White & Geetha Raghuveer

  2. School of Medicine, University of Missouri Kansas City, Kansas City, MO, USA

    David A. White, Gautam M. Anand, Omar Qayum, Chizitam F. Ibezim & Geetha Raghuveer

  3. Division of Health Services and Outcomes Research, Children’s Mercy Hospital, Kansas City, MO, USA

    Ashley K. Sherman

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Correspondence to David A. White.

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All testing and procedures performed in this study involving human participants were in accordance with the ethical standards of The Children’s Mercy Hospital and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All parents of subjects completed an informed consent and subjects completed assent prior to any research-related procedures involved in this study. DW wrote the first draft and every subsequent draft of the manuscript. No honorarium, grant, or any other form of payment was provided to him for writing the manuscript.

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White, D.A., Anand, G.M., Qayum, O. et al. Modifiable Clinical Correlates of Vascular Health in Children and Adolescents with Dyslipidemia. Pediatr Cardiol 40, 805–812 (2019). https://doi.org/10.1007/s00246-019-02071-w

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