Environmental tobacco smoke and carotid intima–media thickness in healthy children and adolescents: a systematic review

Thicker carotid intima–media thickness (CIMT) has been a valid predictor for atherosclerosis development. A significant association between environmental tobacco smoke (ETS) and thickening of CIMT has been demonstrated in adults, whereas such association has scarcely been reviewed in paediatric population. The dominate electronic databases, including MEDLINE (Ovid), PubMed, Embase, CINAHL, Web of Science, Scopus, were searched from inception. Reference lists of retrieved articles were further scanned as to avoid any missing literatures. Newcastle-Ottawa scale was used to assess the quality of the included studies. Qualitative synthesis analyses were performed on the selected studies. 331 articles were retrieved, and 4 were finally selected. All four studies investigated the association between postnatal ETS and CIMT in children, and three of them reported a statistically significant positive association. Three studies investigated the association between prenatal maternal ETS and CIMT, and one of the three found a positive association. Two studies explored the association between postnatal maternal ETS and CIMT, one reported a positive association. Two studies used serum cotinine measurement to quantify ETS and demonstrated potential dose-response relationship with CIMT. ETS exposure may play an independent role in the development of cardiovascular risks in healthy children and adolescents. In the consideration of the great burden of respiratory and cardiovascular diseases, there is an urgent need of effective surveillance for paediatric population’s ETS exposure to reduce smoke exposure.

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Association of Environmental Tobacco Smoke Exposure with Carotid Intima Media Thickness in healthy children and adolescents: a systematic review

10.1183/13993003.congress-2020.1887 ◽

2020 ◽

Author(s):

Siyu Dai ◽

Kate Ching Ching Chan

Keyword(s):

Systematic Review ◽

Children And Adolescents ◽

Environmental Tobacco Smoke ◽

Tobacco Smoke ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Environmental Tobacco Smoke Exposure ◽

Smoke Exposure ◽

Tobacco Smoke Exposure ◽

Healthy Children

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Abstract 170: Re-evaluation of Carotid Intima-Media Thickness by Z-score in Children and Adolescents After Kawasaki Disease

Circulation ◽

10.1161/circ.131.suppl_2.170 ◽

2015 ◽

Vol 131 (suppl_2) ◽

Author(s):

Nobutaka Noto ◽

Masataka Kato ◽

Yuriko Abe ◽

Hiroshi Kamiyama ◽

Kensuke Karasawa ◽

...

Keyword(s):

Kawasaki Disease ◽

Children And Adolescents ◽

Reference Values ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Specific Reference ◽

Healthy Children ◽

Media Thickness ◽

Z Scores ◽

The Mean

Objectives: The carotid intima-media thickness (CIMT) is a reliable screening method for vascular alterations even in a pediatric cohort; however, reference values of CIMT established recently by LMS methods for childhood and adolescence are limited when comparing patients after Kawasaki disease (KD) and controls. We tested the hypothesis that there are significant differences between the values of CIMT expressed as absolute values and z-scores in children and adolescents after KD and controls. Methods: We reviewed 12 published articles regarding CIMT on patients after KD and controls. Absolute values (Ab) of the mean±1 SD of CIMT in patients after KD and controls were transformed to z-scores (Zs) using age-specific reference values established by Jourdan et al. (J: 247 Caucasian subjects aged 10-20 years) and our own data (O: 175 Asian subjects aged 6-20 years), and the results were compared between the two references. In this study, the mean age of the study population derived from each article was designated the representative age for transformation. Results: In either reference (J) or (O), there was no significant sex difference in CIMT at any given age. The mean CIMT of (Ab) and (Zs) transformed by (J) or (O) were significantly different between patients after KD and controls, at 41.6% (Ab), 66.6% (Zs) by (J), and 83.3% (Zs) by (O) among 12 articles, respectively. Therefore, patients after KD had significantly higher (Zs) by (O) than those of controls (0.66±0.71 vs. 0.03±0.68, p=0.006, respectively). Compared with reference values, the controls of (O) were within the normal range. However, there were no significant differences in (Zs) by (J) between the two groups (1.72±0.77 vs. 1.23±0.83, p=0.116, respectively). When we assessed 9 articles dealing with Asian subjects, the difference of (Zs) between the two groups remained significant only by (O) (p=0.015). In contrast, when we assessed 3 articles dealing with mainly Caucasian subjects, there was no significant difference in (Zs) between the two groups with both (J) and (O). Conclusions: These results indicate that age and race-specific reference values for CIMT are mandatory for performing an accurate assessment of the vascular status in healthy children and adolescents and particularly in those after KD.

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