D Meeike Kusters
VU Medical Center, Netherlands
Title: Thicker intima-media thickness in obese children as compared to children with familial hypercholesterolemia: A wake-up call
Biography
Biography: D Meeike Kusters
Abstract
Background: Atherosclerosis initiates early in life, often during childhood. In some children, this process is accelerated owing to genetic or environment factors, such as familial hypercholesterolemia (FH) or obesity. It is well known that children with FH exhibit an increased carotid intima-media thickness (c-IMT), a validated surrogate marker of future cardiovascular disease. Therefore, it is recommended to treat these children with cholesterol-lowering medication starting at the age of eight years. Obesity is strongly associated with a constellation of risk factors for cardiovascular disease (CVD) and it has been shown that childhood obesity also confers a significant risk for CVD events in adulthood. However, no clear recommendations exist as to the treatment of obesity related risk factors during childhood.
Methods: In three cohorts (85 obese children, 171 children with FH and 75 healthy children; all 8-18 years of age), we measured anthropometrics, lipid levels and c-IMT. By means of multivariable linear regression analysis, we compared c-IMT of obese children with c-IMT of children with FH and that of healthy controls.
Results: In obese children (mean age 14.4±2.1 years, mean BMI SDS 4.06±0.4), c-IMT was significantly increased (mean c-IMT 0.476±0.059 mm), not only as compared to healthy children (mean c-IMT 0.432±0.040 mm, P<0.001), but also as compared to children with FH (mean c-IMT 0.441±0.046 mm, P<0.001).
Conclusion: In this study, we have shown for the first time that obese children have a thicker c-IMT than children with FH. This unexpected finding suggests that clustering of risk factors exponentially increases the risk of accelerated atherosclerosis already from a young age. It raises the question whether drug treatment of these risk factors in obesity such as lowering cholesterol, might be justified. Further research should focus on additional imaging studies to learn more about the extent and progression of atherosclerotic abnormalities over time in children with obesity, as well as its possible treatment options.