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• W4280491720 abstract "HomeHypertensionVol. 79, No. 6Carotid Intima-Media Thickness Is Associated With Obesity and Hypertension in Young People Free AccessEditorialPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessEditorialPDF/EPUBCarotid Intima-Media Thickness Is Associated With Obesity and Hypertension in Young People Angela K. Lucas-Herald and Christian Delles Angela K. Lucas-HeraldAngela K. Lucas-Herald Correspondence to: Angela K. Lucas-Herald, Developmental Endocrinology Research Group, School of Medicine, Dentistry and Nursing, Royal Hospital for Children, University of Glasgow, Office Block, 1345 Govan Rd, Glasgow G51 4TF, United Kingdom. Email E-mail Address: [email protected] https://orcid.org/0000-0003-2662-1684 Developmental Endocrinology Research Group, School of Medicine, Dentistry and Nursing, University of Glasgow (A.K.L.-H.), University of Glasgow, United Kingdom. Institute of Cardiovascular and Medical Sciences, British Heart Foundation Centre for Research Excellence (A.K.L.-H., C.D.), University of Glasgow, United Kingdom. Search for more papers by this author and Christian DellesChristian Delles https://orcid.org/0000-0003-2238-2612 Institute of Cardiovascular and Medical Sciences, British Heart Foundation Centre for Research Excellence (A.K.L.-H., C.D.), University of Glasgow, United Kingdom. Search for more papers by this author Originally published11 May 2022https://doi.org/10.1161/HYPERTENSIONAHA.122.19163Hypertension. 2022;79:1177–1179This article is a commentary on the followingCarotid Intima-Media Thickness Percentiles in Adolescence and Young Adulthood and Their Association With Obesity and Hypertensive Blood Pressure in a Population CohortAtherosclerosis is thought to begin silently in childhood and progress throughout life. Fatty atherosclerotic streaks have been seen in children as young as 1 year,1 and carotid intima-media thickness (CIMT) measurements have been used to detect early vascular remodeling, which is likely to persist into adulthood and predispose to later cardiovascular morbidity.2 Reference ranges for CIMT in children are available,3,4 but to date, these have been obtained in small samples and with potential for selection bias of recruitment.See related article, pp 1167–1176The KiGGS study (German Health Interview and Examination Survey for Children and Adolescents) is a nationwide health survey established in Germany, with 26 787 children between the ages of 0 and 17 years recruited.5 As part of their follow-up, they measured CIMT in 4709 young people (50% male) aged between 14 and 28 years, and the reference data obtained from this study are described in this issue of Hypertension.6 The group benefitted from the population-based unselected national recruitment to this cohort and used semiautomated high-resolution B-mode ultrasound of the far wall of the distal common carotid artery to measure CIMT. From these data, Neuhauser et al provide centile charts that have been validated in a large cohort of young people and take into account sex, age, and height, all of which are associated with changes in CIMT. There is no doubt that these charts will, therefore, be invaluable to researchers in the assessment of vascular status in young people.Fat-free mass and systolic blood pressure have been identified as the only modifiable risk factors associated with CIMT in children.7 The authors of this study, therefore, sought to determine the effects of obesity and hypertension on CIMT and used statistical modeling to identify if any particular factors were predictive of increased CIMT. As such, this is the first study to confirm that in young people with obesity or hypertension, CIMT is increased. In particular, in obesity, a high blood pressure reading at the time of CIMT and previous raised blood pressure were found to be prognostic of increased CIMT, findings that should emphasize to clinicians the need to be vigilant with blood pressure screening and management in childhood.That said, there are some limitations to these data. Nearly a quarter of the young people in this study were of a migrant background, defined as at least one parent who had emigrated to Germany or had a non-German nationality. It is not clear which non-White ethnicities are included in the sample or whether the CIMT values obtained differed in these groups, and this must be considered when using the values internationally. In addition, data are presented in children over the age of 14 years, and it is assumed that most of these children will, therefore, be postpubertal, but no pubertal assessments have been included. Puberty is a time of significant hormonal fluctuations, and given that the sex steroids are vasoactive, it is difficult to ignore the likelihood of variable vascular phenotypes in pre- and postpubertal children, although this has not yet been studied definitively. In adults, CIMT varies with sex and ethnicity,8 so these omissions should be taken into account when using them to calculate a CIMT Z score in a young person. Indeed, as demonstrated in the Figure, there are many variables that may affect CIMT and progression to end organ disease, all of which should be considered when reviewing the data from this study.Download figureDownload PowerPointFigure. Interplay between carotid intima-media thickness (CIMT) development, obesity, and other modifiable and nonmodifiable factors .There is progression from normal to increased CIMT to overt cardiovascular disease (CVD), including stroke. Obesity is a risk factor for this and is associated with this progression, but other modifiable and nonmodifiable risk factors are involved. Obesity can also affect progression to CVD by interaction with these shared risk factors. CKD indicates chronic kidney disease.Finally, these data are part of a thorough large-scale population study, and as such, all measurements have been obtained using standardized equipment and techniques with staff rigorously trained in CIMT assessment to produce consistent results. It is, therefore, not clear whether these centiles would remain valid with variations of equipment and protocol in centers outwith this study. It is hoped that studies like these will inspire standardization of the approach to noninvasive vascular phenotyping in children and young people.In conclusion, Neuhauser et al provide robust evidence of the association between hypertension, obesity, and increased CIMT, as well as centile charts for the assessment of CIMT Z scores in young people, which are adjusted for height, age, and sex. As with any reference data, however, on an individual level, consideration must be taken into whether they are applicable for any population being studied before use.Article InformationSources of FundingA.K. Lucas-Herald is a clinical lecturer funded by the National Education for Scotland and the Chief Scientist Office. C. Delles is supported by the British Heart Foundation (Centre of Research Excellence, reference RE/18/6/34217).Disclosures None.FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.For Sources of Funding and Disclosures, see page 1178.Correspondence to: Angela K. Lucas-Herald, Developmental Endocrinology Research Group, School of Medicine, Dentistry and Nursing, Royal Hospital for Children, University of Glasgow, Office Block, 1345 Govan Rd, Glasgow G51 4TF, United Kingdom. Email angela.[email protected]ac.ukReferences1. Strong JP, Mcgill HC. The natural history of coronary atherosclerosis.Am J Pathol. 1962; 40:37–49.MedlineGoogle Scholar2. Davis PH, Dawson JD, Riley WA, Lauer RM. Carotid intimal-medial thickness is related to cardiovascular risk factors measured from childhood through middle age: the Muscatine Study.Circulation. 2001; 104:2815–2819. doi: 10.1161/hc4601.099486LinkGoogle Scholar3. Doyon A, Kracht D, Bayazit AK, Deveci M, Duzova A, Krmar RT, Litwin M, Niemirska A, Oguz B, Schmidt BMW, et al. Carotid artery intima-media thickness and distensibility in children and adolescents: reference values and role of body dimensions.Hypertension. 2013; 62:550–556. doi: 10.1161/HYPERTENSIONAHA.113.01297LinkGoogle Scholar4. Semmler L, Weberruß H, Baumgartner L, Pirzer R, Oberhoffer-Fritz R. Vascular diameter and intima-media thickness to diameter ratio values of the carotid artery in 642 healthy children.Eur J Pediatr. 2021; 180:851–860. doi: 10.1007/s00431-020-03785-3CrossrefMedlineGoogle Scholar5. Mauz E, Lange M, Houben R, Hoffmann R, Allen J, Gößwald A, Hölling H, Lampert T, Lange C, Poethko-Müller C, et al; KiGGS Cohort Research Team. Cohort profile: KiGGS cohort longitudinal study on the health of children, adolescents and young adults in Germany.Int J Epidemiol. 2020; 49:375–375k. doi: 10.1093/ije/dyz231CrossrefMedlineGoogle Scholar6. Neuhauser HK, Bueschges J, Rosario AS, Schienkiewitz A, Sarganas G, Konigstein K, Schweizer D, Schmidt-Trucksäss A. Carotid intima-media thickness percentiles in adolescence and young adulthood and their association with obesity and hypertensive blood pressure in a population cohort.Hypertension. 2022; 79:1167–1176. doi: 10.1161/HYPERTENSIONAHA.121.18521LinkGoogle Scholar7. Chiesa Scott T, Charakida M, Georgiopoulos G, Dangardt F, Wade Kaitlin H, Rapala A, Bhowruth DJ, Nguyen HC, Muthurangu V, Shroff R, et al. Determinants of intima-media thickness in the young.JACC Cardiovasc Imaging. 2021; 14:468–478. doi: 10.1016/j.jcmg.2019.08.026CrossrefMedlineGoogle Scholar8. Urbina EM, Williams RV, Alpert BS, Collins RT, Daniels SR, Hayman L, Jacobson M, Mahoney L, Mietus-Snyder M, Rocchini A, et al; American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee of the Council on Cardiovascular Disease in the Young. Noninvasive assessment of subclinical atherosclerosis in children and adolescents: recommendations for standard assessment for clinical research: a scientific statement from the American Heart Association.Hypertension. 2009; 54:919–950. doi: 10.1161/HYPERTENSIONAHA.109.192639LinkGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsRelated articlesCarotid Intima-Media Thickness Percentiles in Adolescence and Young Adulthood and Their Association With Obesity and Hypertensive Blood Pressure in a Population CohortHannelore K. Neuhauser, et al. Hypertension. 2022;79:1167-1176 June 2022Vol 79, Issue 6 Advertisement Article InformationMetrics © 2022 American Heart Association, Inc.https://doi.org/10.1161/HYPERTENSIONAHA.122.19163PMID: 35544586 Originally publishedMay 11, 2022 PDF download Advertisement SubjectsClinical Studies" @default.
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