Subclinical atherosclerosis in children and adolescents with congenital heart disease

2020 ◽  
pp. 1-8
Author(s):  
Silvia M. Cardoso ◽  
Michele Honicky ◽  
Yara M. F. Moreno ◽  
Luiz R. A. de Lima ◽  
Matheus A. Pacheco ◽  
...  
Keyword(s):  
Risk Factors ◽  
Congenital Heart Disease ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Clinical Characteristics ◽  
Congenital Heart ◽  
Subclinical Atherosclerosis ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Media Thickness

Abstract Background: Subclinical atherosclerosis in childhood can be evaluated by carotid intima-media thickness, which is considered a surrogate marker for atherosclerotic disease in adulthood. The aims of this study were to evaluate carotid intima-media thickness and, to investigate associated factors. Methods: Cross-sectional study with children and adolescents with congenital heart disease (CHD). Socio-demographic and clinical characteristics were assessed. Subclinical atherosclerosis was evaluated by carotid intima-media thickness. Cardiovascular risk factors, such as physical activity, screen time, passive smoke, systolic and diastolic blood pressure, waist circumference, dietary intake, lipid parameters, glycaemia, and C-reactive protein, were also assessed. Factors associated with carotid intima-media thickness were analysed using multiple logistic regression. Results: The mean carotid intima-media thickness was 0.518 mm and 46.7% had subclinical atherosclerosis (carotid intima-media thickness ≥ 97th percentile). After adjusting for confounding factors, cyanotic CHD (odds ratio: 0.40; 95% confidence interval: 0.20; 0.78), cardiac surgery (odds ratio: 3.17; 95% confidence interval: 1.35; 7.48), and be hospitalised to treat infections (odds ratio: 1.92; 95% confidence interval: 1.04; 3.54) were associated with subclinical atherosclerosis. Conclusion: Clinical characteristics related to CHD were associated with subclinical atherosclerosis. This finding suggests that the presence of CHD itself is a risk factor for subclinical atherosclerosis. Therefore, the screen and control of modifiable cardiovascular risk factors should be made early and intensively to prevent atherosclerosis.

scholarly journals Meta-analysis of epigenome-wide association studies of carotid intima-media thickness

2021 ◽  
Author(s):  
Eliana Portilla-Fernández ◽  
Shih-Jen Hwang ◽  
Rory Wilson ◽  
Jane Maddock ◽  
W. David Hill ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Dna Methylation ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Association Studies ◽  
Subclinical Atherosclerosis ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Media Thickness

AbstractCommon carotid intima-media thickness (cIMT) is an index of subclinical atherosclerosis that is associated with ischemic stroke and coronary artery disease (CAD). We undertook a cross-sectional epigenome-wide association study (EWAS) of measures of cIMT in 6400 individuals. Mendelian randomization analysis was applied to investigate the potential causal role of DNA methylation in the link between atherosclerotic cardiovascular risk factors and cIMT or clinical cardiovascular disease. The CpG site cg05575921 was associated with cIMT (beta = −0.0264, p value = 3.5 × 10–8) in the discovery panel and was replicated in replication panel (beta = −0.07, p value = 0.005). This CpG is located at chr5:81649347 in the intron 3 of the aryl hydrocarbon receptor repressor gene (AHRR). Our results indicate that DNA methylation at cg05575921 might be in the pathway between smoking, cIMT and stroke. Moreover, in a region-based analysis, 34 differentially methylated regions (DMRs) were identified of which a DMR upstream of ALOX12 showed the strongest association with cIMT (p value = 1.4 × 10–13). In conclusion, our study suggests that DNA methylation may play a role in the link between cardiovascular risk factors, cIMT and clinical cardiovascular disease.

scholarly journals Is Carotid Intima‐Media Thickness Increased in Adults With Congenital Heart Disease?

2020 ◽  
Vol 9 (3) ◽  
Author(s):  
Barbara Reiner ◽  
Renate Oberhoffer ◽  
Anna‐Luisa Häcker ◽  
Peter Ewert ◽  
Jan Müller
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Media Thickness

scholarly journals Subclinical Atherosclerosis Progression in Obese Children with Relevant Cardiometabolic Risk Factors Can Be Assessed through Carotid Intima Media Thickness

2021 ◽  
Vol 11 (22) ◽  
pp. 10721
Author(s):  
Monica-Simina Mihuta ◽  
Corina Paul ◽  
Adrian Ciulpan ◽  
Farah Dacca ◽  
Iulian Puiu Velea ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Cardiometabolic Risk ◽  
Subclinical Atherosclerosis ◽  
Automatic Measurement ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Complete Evaluation ◽  
Media Thickness ◽  
Lipid Panel

Given the growing obesity rates among children, a more complete evaluation of their potential cardiometabolic risk is needed. Carotid intima-media thickness (CIMT), a marker of endothelial distress and a predictor of atherosclerotic progression in adulthood, may complete the day-to-day evaluation of children at risk. Multiple risk factors act as additional precipitant causes of atherosclerosis. We analyzed 60 patients aged 6–17 years old by measuring their CIMT using the Aixplorer MACH 30 echography machine automatic measurement software. All subjects were clinically and anamnestically assessed to identify risk factors. CIMT values are significantly higher in older children and boys. Over 20 kg weight gain during pregnancy and other at-risk disorders (p = 0.047), family history of cardiovascular risk (p = 0.049), hypertension (p = 0.012), and smoking (p = 0.015) are linked to increased CIMT. Our study also supports international data on artificial postnatal nutrition, high/low birth weight, and sedentary lifestyle being linked to increased CIMT. Significant correlations were detected between CIMT and the entire lipid panel. Weight excess and abdominal adiposity in children is clearly linked to increased CIMT. Moreover, waist circumference and TG/HDL-c are significant predictors of CIMT. Although each parameter of the lipid panel is correlated to CIMT, fasting glucose is not.

Carotid Intima–Media Thickness in Children and Adolescents With Congenital Heart Disease

2018 ◽  
Vol 34 (12) ◽  
pp. 1618-1623 ◽  
Author(s):  
Barbara Reiner ◽  
Renate Oberhoffer ◽  
Anna-Luisa Häcker ◽  
Peter Ewert ◽  
Jan Müller
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Children And Adolescents ◽  
Congenital Heart ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Media Thickness

scholarly journals Prevalence of Microalbuminuria and Its Association with Subclinical Carotid Atherosclerosis in Middle Aged, Nondiabetic, Low to Moderate Cardiovascular Risk Individuals with or without Hypertension

Diagnostics ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 1716
Author(s):  
Eva Szabóová ◽  
Alexandra Lisovszki ◽  
Eliška Fatľová ◽  
Peter Kolarčik ◽  
Peter Szabó ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Carotid Plaque ◽  
Subclinical Atherosclerosis ◽  
Multiple Logistic Regression Analysis ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Functional Markers ◽  
Middle Aged ◽  
Media Thickness

Microalbuminuria is closely associated with the risk of cardiovascular disease and all-cause mortality in the general population. Less is known about its relationship with subclinical atherosclerosis. We aimed to assess the prevalence of microalbuminuria and its relationship with subclinical atherosclerosis in middle-aged, nondiabetic, apparently healthy individuals (N = 187; 40.1% men, 59.9% women; aged 35–55 years) as well as to evaluate its potential associations with established risk modifiers, especially with the presence of carotid plaque. Clinical and laboratory parameters, the estimated 10-year fatal cardiovascular risk (SCORE), as well as circulating, functional (flow mediated vasodilation, ankle-brachial index, augmentation index, and pulse wave velocity), and morphological markers (mean carotid intima–media thickness, and carotid plaque) of subclinical atherosclerosis were analysed in group with vs. without microalbuminuria. Microalbuminuria was present in 3.8% of individuals with SCORE risk 0.43 ± 0.79%. Functional markers predominated in both groups. Carotid intima–media thickness (mean ± SD) in both groups was in range: 0.5–0.55 ± 0.09–0.14 mm. Carotid plaque was more frequent in group with (14.3%) vs. without (4.4%) microalbuminuria. Microalbuminuria had no statistically significant effect on most markers of subclinical atherosclerosis, but the increasing value of microalbuminuria was significantly associated with the occurrence of carotid plaque (p = 0.035; OR = 1.035; 95% CI = 1.002–1.07). Additional multiple logistic regression analysis, where variables belonged to microalbuminuria, number of risk factors, and family history, finally showed only two variables: microalbuminuria (p = 0.034; OR = 1.04; 95%CI = 1.003–1.09) and the number of risk factors (p = 0.006; OR = 2.15; 95% CI = 1.24–3.73) with independent and significant impact on the occurrence of carotid plaque. Our results may indicate an association of microalbuminuria with the presence of carotid atherosclerotic plaque; in addition, microalbuminuria and the number of risk factors appear to be possible predictors of the carotid plaque occurrence. Monitoring microalbuminuria may improve the personalized cardiovascular risk assessment in nondiabetic, low-to-moderate cardiovascular risk individuals with or without hypertension.

Risk Factors for Candidemia in Pediatric Patients With Congenital Heart Disease

2006 ◽  
Vol 27 (6) ◽  
pp. 576-580 ◽  
Author(s):  
Lucía García-San Miguel ◽  
Javier Cobo ◽  
Isabel Martos ◽  
Enrique Otheo ◽  
Alfonso Muriel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Confidence Interval ◽  
Antibiotic Therapy ◽  
Clinical Management ◽  
Odds Ratio ◽  
Congenital Heart ◽  
Tertiary Care ◽  
Surveillance Culture

Objective.To identify the main risk factors for the acquisition of candidemia in children with congenital heart disease (CHD) in order to improve the clinical management of these patients.Design.A case-control study.Setting.A large tertiary-care referral center in Spain with a pediatric intensive care unit (PICU) to which more than 500 children with CHD are admitted annually.Patients.All patients had CHD and were admitted to the PICU during 1995-2000. Case patients were defined as patients with candidemia, and control patients were defined as patients without candidemia.Results.Twenty-eight case patients and 47 control subjects were included in the study. Case patients were younger (mean age [ ± SD], 12.5 ± 32.0 vs 38.0 ± 48.0 months;P< .01) and had a longer median PICU stay (19 vs 4 days;P< .01), and a greater percentage of case patients previously hadCandidaspecies isolated from specimens other than blood (eg, bronchial aspirates, urine, or skin specimens) (39% vs 4%;P<.01). Severity of clinical condition, as measured by the Therapeutic Intervention Scoring System (TISS) 1 week after PICU admission (odds ratio, 1.15; 95% confidence interval, 1.05-1.26;P<.01), and receipt of antibiotic treatment for more than 5 days (odds ratio, 13.42; 95% confidence interval, 1.31-137.13;P= .03) were independently associated with the development of candidemia.Conclusions.Patients with CHD who have a high TISS score 1 week after PICU admission and patients who have received prolonged antibiotic therapy should be considered at high risk for candidemia. Our results suggest that shorter courses of antibiotic therapy, routine surveillance culture forCandidaspecies, and initiation of preemptive or empirical antifungal treatment could help in the clinical management of these patients.

scholarly journals Similar progression of carotid intima–media thickness in 7-year surveillance of patients with mild SLE and controls, but this progression is still promoted by dyslipidaemia, lower HDL levels, hypertension, history of lupus nephritis and a higher prednisolone usage in patients

2020 ◽  
Vol 7 (1) ◽  
pp. e000362 ◽  
Author(s):  
Sofia Ajeganova ◽  
Thomas Gustafsson ◽  
Linnea Lindberg ◽  
Ingiäld Hafström ◽  
Johan Frostegård
Keyword(s):  
Risk Factors ◽  
Lupus Nephritis ◽  
Carotid Plaque ◽  
Subclinical Atherosclerosis ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Average Dose ◽  
Media Thickness ◽  
History Of

ObjectiveTo compare progression of subclinical atherosclerosis and factors promoting it in patients with SLE and controls.MethodsConsecutive patients with SLE and age-matched, sex-matched population controls from the SLEVIC cohort were assessed at inclusion and after 7 years with standardised data collection and carotid ultrasound. Effect of risk factors on carotid intima–media thickness (cIMT) progression was examined with adjusted linear mixed models.ResultsA total of 77 patients and 74 controls, 68% and 61% of the original cohort, completed follow-up. The patients were (mean) 47 years old, 90% were women, and controls were 51 years old, 92% women. Patients had disease duration of (mean) 11 years, mild disease activity and low severity at both assessments. Baseline cIMT did not differ between the groups. An average absolute cIMT progression was 0.009 mm/year in patients and 0.011 mm/year in controls, intergroup difference p=0.9.Of factors at inclusion, dyslipidaemia, lower levels of high-density lipoprotein (HDL) and carotid plaque in patients and controls, and higher systolic blood pressure, total cholesterol:HDL and LDL:HDL ratios and triglycerides in patients were associated with cIMT progression. Of factors at follow-up, hypertension and blood lipids in patients and HDL in controls were significantly associated with cIMT progression. History of lupus nephritis and a higher average dose of prednisolone used since diagnosis were associated with cIMT progression in patients. Associations of risk factors with cIMT progression were stronger in presence of plaques.ConclusionWe observed a statistically comparable progression of cIMT in patients with mild SLE and controls over 7 years, which implies that progression of subclinical atherosclerosis in some patients with SLE could follow that of the general population. Traditional cardiovascular (CV) risk factors, history of lupus nephritis and higher use of corticosteroids promote cIMT progression in SLE. Detection of carotid plaque may add to CV risk stratification.

Risk factors for loss to follow-up among children and young adults with congenital heart disease

2011 ◽  
Vol 22 (3) ◽  
pp. 307-315 ◽  
Author(s):  
Andrew S. Mackie ◽  
Gwen R. Rempel ◽  
Kathryn N. Rankin ◽  
David Nicholas ◽  
Joyce Magill-Evans
Keyword(s):  
Risk Factors ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Congenital Heart ◽  
Family Income ◽  
Loss To Follow Up ◽  
History Of

AbstractObjectiveTo identify risk factors for loss to cardiology follow-up among children and young adults with congenital heart disease.MethodsWe used a matched case-control design. Cases were born before January, 2001 with moderate or complex congenital heart disease and were previously followed up in the paediatric or adult cardiology clinic, but not seen for 3 years or longer. Controls had been seen within 3 years. Controls were matched 3:1 to cases by year of birth and congenital heart disease lesion. Medical records were reviewed for potential risk factors for loss to follow-up. A subset of cases and controls participated in recorded telephone interviews.ResultsA total of 74 cases (66% male) were compared with 222 controls (61% male). A history of missed cardiology appointments was predictive of loss to follow-up for 3 years or longer (odds ratio 13.0, 95% confidence interval 3.3–51.7). Variables protective from loss to follow-up were higher family income (odds ratio 0.87 per $10,000 increase, 0.77–0.98), cardiac catheterisation within 5 years (odds ratio 0.2, 95% confidence interval 0.1–0.6), and chart documentation of the need for cardiology follow-up (odds ratio 0.4, 95% confidence interval 0.2–0.8). Cases lacked awareness of the importance of follow-up and identified primary care physicians as their primary source of information about the heart, rather than cardiologists. Unlike cases, controls had methods to remember appointments.ConclusionsA history of one or more missed cardiology appointments predicted loss to follow-up for 3 or more years, as did lack of awareness of the need for follow-up. Higher family income, recent catheterisations, and medical record documentation of the need for follow-up were protective.

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