Preclinical Aortic Atherosclerosis in Adolescents With Chronic Disease
Ververs, Francesca A; Eikendal, Anouk L M; Kofink, Daniel; Nuboer, Roos; Westenberg, Jos J M; Hovenkamp, Gijs T; Kemps, Jitske J A; Coenen, Iris C J; Daems, Joëlle J N; Claus, Laura R; Ju, Yillie; Wulffraat, Nico M; van der Ent, Cornelis K; Monaco, Claudia; Boes, Marianne; Leiner, Tim; Grotenhuis, Heynric B; Schipper, Henk S
(2022) Journal of the American Heart Association, volume 11, issue 14, pp. 1 - 18
(Article)
Abstract
Background Adolescents with chronic disease are often exposed to inflammatory, metabolic, and hemodynamic risk factors for early atherosclerosis. Since postmortem studies have shown that atherogenesis starts in the aorta, the CDACD (Cardiovascular Disease in Adolescents with Chronic Disease) study investigated preclinical aortic atherosclerosis in these adolescents. Methods and Results The
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cross-sectional CDACD study enrolled 114 adolescents 12 to 18 years old with chronic disorders including juvenile idiopathic arthritis, cystic fibrosis, obesity, corrected coarctation of the aorta, and healthy controls with a corrected atrial septal defect. Cardiovascular magnetic resonance was used to assess aortic pulse wave velocity and aortic wall thickness, as established aortic measures of preclinical atherosclerosis. Cardiovascular magnetic resonance showed a higher aortic pulse wave velocity, which reflects aortic stiffness, and higher aortic wall thickness in all adolescent chronic disease groups, compared with controls ( P<0.05). Age (β=0.253), heart rate (β=0.236), systolic blood pressure (β=-0.264), and diastolic blood pressure (β=0.365) were identified as significant predictors for aortic pulse wave velocity, using multivariable linear regression analysis. Aortic wall thickness was predicted by body mass index (β=0.248) and fasting glucose (β=0.242), next to aortic lumen area (β=0.340). Carotid intima-media thickness was assessed using ultrasonography, and was only higher in adolescents with coarctation of the aorta, compared with controls ( P<0.001). Conclusions Adolescents with chronic disease showed enhanced aortic stiffness and wall thickness compared with controls. The enhanced aortic pulse wave velocity and aortic wall thickness in adolescents with chronic disease could indicate accelerated atherogenesis. Our findings underscore the importance of the aorta for assessment of early atherosclerosis, and the need for tailored cardiovascular follow-up of children with chronic disease.
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Keywords: Adolescent, Aortic Coarctation/complications, Aortic Diseases/complications, Atherosclerosis/etiology, Carotid Intima-Media Thickness, Child, Chronic Disease, Cross-Sectional Studies, Humans, Pulse Wave Analysis, Vascular Stiffness/physiology, atherosclerosis, cIMT, adolescents, CMR, children, chronic disease, Cardiology and Cardiovascular Medicine, Journal Article
ISSN: 2047-9980
Publisher: Wiley-Blackwell
Note: Funding Information: the Nutricia Research Fund. Henk Schipper was supported by a VENI-NWO Innovational Research Incentive (grant number 91618150). Funding Information: This work was financially supported by the Wilhelmina Children’s Hospital Research Fund, Dutch Topsector Life Sciences and Health TKI fund, and Funding Information: This work was financially supported by the Wilhelmina Children’s Hospital Research Fund, Dutch Topsector Life Sciences and Health TKI fund, and the Nutricia Research Fund. Henk Schipper was supported by a VENI-NWO Innovational Research Incentive (grant number 91618150). Publisher Copyright: © 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
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