Cardiovascular Risk in Childhood Obesity
Macroangiopathy caused by atherosclerosis is one of the major morbidity and mortality factors in obese adults with dyslipidaemia, hypertension, and disturbed glucose metabolism. However, the onset of these cardiovascular changes is not well established. M
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Cardiovascular Risk in Childhood Obesity Thomas Reinehr
Obesity in childhood is an increasing phenomenon (Livingstone 2000). Childhood obesity has a wide range of serious complications and increases the risk of early illness and death in later life (Freedman et al. 1999; Ebbeling et al. 2002). As in adulthood, obesity in childhood contributes to an increased prevalence of cardiovascular risk factors, such as hypertension, dyslipidaemia, and impaired glucose metabolism (Freedman et al. 1999; Ebbeling et al. 2002). It is discussed that the exposure to these cardiovascular risk factors in early life may induce changes in the arteries contributing to the development of atherosclerosis in adulthood (Atabek et al. 2007). In adults detectable abnormalities in vascular function typically precede the development of vascular anatomical pathology (Koskinen et al. 2009; Halcox et al. 2009). Vascular dysfunction, including reduced endothelial function and arterial compliance and increased inflammatory markers, is detectable in obese and diabetic subjects prior to the appearance of anatomical abnormalities (Koskinen et al. 2009; Halcox et al. 2009). This has led to the postulated sequence of events whereby early changes in vascular risk factors such as obesity, hyperlipidaemia, hypertension, and impaired glycaemia promote initial endothelial dysfunction and stiffness of small vessels. Inflammation and continued presence of these risk factors lead subsequently to atherosclerotic development with altered vascular structure and increased stiffness of the large vessels (Duprez et al. 2005). A measurement of these early cardiovascular changes, which is predictive for later atherosclerotic disease, would be ideal especially in childhood to describe the cardiovascular risk. Measuring the intima-media thickness (IMT) has been reported as a new non-invasive marker for these early cardiovascular changes, which is
T. Reinehr (*) Head of the Department of Paediatric Endocrinology, Diabetes, and Nutrition Medicine, Vestische Hospital for Children and Adolescents, University of Witten/Herdecke, Dr. F. Steiner Str. 5, 45711 Datteln, Germany e-mail: [email protected] K. Widhalm and G. Prager (eds.), Morbid Obesity in Adolescents, DOI 10.1007/978-3-7091-0968-7_18, © Springer-Verlag Wien 2015
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predictive for later CVD and strokes in adults (Davis et al. 2001; Hurwitz and Netterstrom 2001; Lorenz et al. 2007).
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Determination of IMT
Measurement of IMT is performed using high-resolution ultrasonography, most often at the carotid artery (CCA), though peripheral sites have also been examined. Images typically are collected from the leading edge of the lumen–intima interface on the far wall of the CCA. Visualisation of IMT can be challenging because the vessel thickness is small (reported average values in normal and obese children and adults range from 0.34 to 0.80 mm) (Wunsch et al. 2007). New developments like Tissue Harmonic Imaging (THI), Speckle Reduction Imaging (SRI), and Real-time compound/Cross-
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