Uncontrolled CVD Risk Factors in Teens Flag Organ Damage

Megan Brooks

September 24, 2020

The presence of cardiovascular disease (CVD) risk factors in adolescence predicts target organ damage at a young age, supporting the concept that adult CVD has its origins in childhood, researchers say.

"There are more and more obese children with high cholesterol and early insulin resistance who are at very high risk of developing CVD as they transition into adulthood. What we don't know is if these same children have evidence of early damage in their hearts, blood vessels, or kidneys," Joshua J. Price, MD, pediatric cardiology fellow, Seattle Children's Hospital, told theheart.org | Medscape Cardiology.

"Our study shows that healthy adolescents with risk factors for CVD are more likely to have subclinical target organ damage in the heart and blood vessels than adolescents without those same risk factors," said Price.

The findings were presented at the virtual American Heart Association (AHA) Hypertension Scientific Sessions 2020.

Intervene Early

Price and colleagues studied 385 otherwise healthy adolescents, average age 15 years, who were assessed for metabolic risk factors for CVD and target organ damage as part of the SHIP AHOY study.

For each adolescent, a cardiovascular (CV) risk score was calculated, with 1 point each for LDL above 155 mg/dL or HDL below 40 mg/dL or triglycerides above 150 mg/dL; BMI above the 95th percentile; fasting glucose above 100 mg/dL; and a homeostatic model assessment of insulin resistance (HOMA-IR) score above 2.5.

Ninety adolescents had a score of 0 (low risk), 182 had a score of 1 or 2 (mid risk) and 113 had a score of 3 or 4. The researchers constructed generalized linear models to determine if the CV risk score was independently associated with measures of target organ damage.

After correction for age, sex, race, heart rate, creatinine, uric acid, and C-reactive protein, the CV risk score was significantly associated with left ventricular mass index (β, 1.64; R2, 0.19; P ≤ .0001), increased pulse wave velocity (β, 0.05; R2, 0.21; P ≤ .0001), and several echocardiographic parameters of diastolic dysfunction, namely E/e´ (β, 0.03; R2, 0.13; = .03); E/A (β, –0.04; R2, 0.11; ≤ .0001); and e´/a´ (β, –0.07; R2, 0.27; ≤ .0001).

CV risk score was not associated with microalbuminuria.

These results show that an adverse metabolic profile is associated with early markers of subclinical target organ damage in adolescents, Price told theheart.org | Medscape Cardiology.

"Being aggressive about treating diseases like obesity, insulin resistance, and hyperlipidemia is crucial to save lives in adulthood and maybe even to prevent subclinical organ damage at a young age," he said.

"The next steps will be to determine if treating these risk factors can prevent the development of this target organ damage in children," Price added.

Important Findings

Reached for comment, Joseph Mahgerefteh, MD, director, preventive cardiology, Kravis Children's Hospital at Mount Sinai, New York City, said the findings are "very important and add to our previous knowledge on impact of cardiovascular risk factors. This study demonstrated that clustering of cardiovascular risk factors related to early unfavorable changes in cardiovascular system."

It's particularly noteworthy, said Mahgerefteh, that despite the "minor degree" of risk factors, the medium risk group demonstrated "unfavorable adaptation in their cardiac size, cardiac relaxation, and vascular health. The values are still in normal range, but the fact that they are affected is very important."

"These findings make me be more vigilant at lower levels of risk. I plan to share these findings when counseling families and patients and advocate for healthy diet and lifestyle (increasing activities, improve weight, and decrease/remove simple sugar and sugar-sweetened beverages from their diet)," Mahgerefteh told theheart.org | Medscape Cardiology.

The study was funded by grants from the American Heart Association and the National Institutes of Health. Price and Mahgerefteh have no relevant disclosures.

Hypertension 2020 Scientific Sessions: Abstract MP16. Presented September 10, 2020.


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