The Cardiovascular Stress Response as Early Life Marker of Cardiovascular Health: Applications in Population-Based Pedia
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ORIGINAL ARTICLE
The Cardiovascular Stress Response as Early Life Marker of Cardiovascular Health: Applications in Population‑Based Pediatric Studies—A Narrative Review Meddy N. Bongers‑Karmaoui1,2 · Vincent W. V. Jaddoe1,2 · Arno A. W. Roest3 · Romy Gaillard1,2 Received: 9 April 2020 / Accepted: 7 August 2020 © The Author(s) 2020
Abstract Stress inducement by physical exercise requires major cardiovascular adaptations in both adults and children to maintain an adequate perfusion of the body. As physical exercise causes a stress situation for the cardiovascular system, cardiovascular exercise stress tests are widely used in clinical practice to reveal subtle cardiovascular pathology in adult and childhood populations with cardiac and cardiovascular diseases. Recently, evidence from small studies suggests that the cardiovascular stress response can also be used within research settings to provide novel insights on subtle differences in cardiovascular health in non-diseased adults and children, as even among healthy populations an abnormal response to physical exercise is associated with an increased risk of cardiovascular diseases. This narrative review is specifically focused on the possibilities of using the cardiovascular stress response to exercise combined with advanced imaging techniques in pediatric population-based studies focused on the early origins of cardiovascular diseases. We discuss the physiology of the cardiovascular stress response to exercise, the type of physical exercise used to induce the cardiovascular stress response in combination with advanced imaging techniques, the obtained measurements with advanced imaging techniques during the cardiovascular exercise stress test and their associations with cardiovascular health outcomes. Finally, we discuss the potential for cardiovascular exercise stress tests to use in pediatric population-based studies focused on the early origins of cardiovascular diseases. Keywords Epidemiology · Pediatric cardiology · Exercise · MRI
Introduction Cardiovascular diseases are a major public health problem worldwide [1]. Because of the large clinical impact that cardiovascular diseases have in adulthood, most research has focused on adult populations. Accumulating evidence suggests that cardiovascular diseases may at least partly originate in the earliest phase of life [2, 3]. Adverse exposures acting at different stages of fetal and early postnatal * Romy Gaillard [email protected] 1
The Generation R Study Group, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
2
Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
3
Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
development, may lead to permanent adaptations in the structure, physiology and function of cardiovascular organ systems, predisposing to an increased risk of cardiovascular risk factors in childhood and cardiovascular disease in later life [4–7]. It is well-known that
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