Korean Circ J.  2010 Jan;40(1):1-9. 10.4070/kcj.2010.40.1.1.

Atherosclerotic Cardiovascular Disease Beginning in Childhood

Affiliations
  • 1Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea. hongym@chollian.net

Abstract

Although the clinical manifestations of cardiovascular disease (CVD), such as myocardial infarction, stroke, and peripheral vascular disease, appear from middle age, the process of atherosclerosis can begin early in childhood. The early stage and progression of atherosclerosis in youth are influenced by risk factors that include obesity, hypertension, dyslipidemia, and smoking, and by the presence of specific diseases, such as diabetes mellitus and Kawasaki disease (KD). The existing evidence indicates that primary prevention of atherosclerotic disease should begin in childhood. Identification of children at risk for atherosclerosis may allow early intervention to decrease the atherosclerotic process, thereby preventing or delaying CVD. This review will describe the origin and progression of atherosclerosis in childhood, and the identification and management of known risk factors for atherosclerotic CVD in children and young adults.

Keyword

Atherosclerosis; Cardiovascular diseases; Child; Adolescent; Primary prevention

MeSH Terms

Adolescent
Atherosclerosis
Cardiovascular Diseases
Child
Diabetes Mellitus
Dyslipidemias
Early Intervention (Education)
Humans
Hypertension
Middle Aged
Mucocutaneous Lymph Node Syndrome
Myocardial Infarction
Obesity
Peripheral Vascular Diseases
Primary Prevention
Risk Factors
Smoke
Smoking
Stroke
Young Adult
Smoke

Figure

  • Fig. 1 Natural history of atherosclerosis.

  • Fig. 2 Estimated probability of advanced atherosclerotic lesions in the coronary arteries by PDAY risk scores. PDAY: Pathobiological Determinants of Atherosclerosis in Youth.

  • Fig. 3 Risk-stratification and treatment algorithm for high-risk pediatric populations. Detailed informations on the treatment recommendations are available at Ref.40)41) Step 4-for tier I, initial management is therapeutic lifestyle change plus disease-specific management, while for tiers II and III, initial management is therapeutic lifestyle change; Step 5-for tiers II and III, if goals are not met after initial management, consider medication. FH: familial hypercholesterolemia, ESRD: end-stage renal disease, CV: cardiovascular, CAD: coronary artery disease, BP: blood pressure, LDL: low-density lipoprotein, FG: fasting glucose, HgbA1c: hemoglobin A1C, ht: height, pt: patient.


Reference

1. McGill HC Jr, McMahan CA, Herderick EE, Malcom GT, Tracy RE, Strong JP. Origin of atherosclerosis in childhood and adolescence. Am J Clin Nutr. 2000. 72(5):Suppl. 1307S–1315S.
2. Enos WF, Holmes RH, Beyer J. Coronary disease among United States soldiers killed in action in Korea: preliminary report. J Am Med Assoc. 1953. 152:1090–1093.
3. McNamara JJ, Molot MA, Stremple JF, Cutting RT. Coronary artery disease in combat casualties in Vietnam. JAMA. 1971. 216:1185–1187.
4. Stary HC. Evolution and progression of atherosclerotic lesions in coronary arteries in children and young adults. Arteriosclerosis. 1989. 9:Suppl I. I19–I32.
5. Tanaka K, Masuda J, Imamura T, et al. A nation-wide study of atherosclerosis in infants, children and young adults in Japan. Atherosclerosis. 1988. 72:143–156.
6. Imakita M, Yutani C, Strong JP, et al. Second nation-wide study of atherosclerosis in infants, children and young adults in Japan. Atherosclerosis. 2001. 155:487–497.
7. Berenson GS, Srinivasan SR, Bao W, Newman WP 3rd, Tracy RE, Wattigney WA. The Bogalusa Heart Study. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. N Engl J Med. 1998. 338:1650–1656.
8. McGill HC Jr, McMahan CA, Zieske AW, et al. The Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. Associations of coronary heart disease risk factors with the intermediate lesion of atherosclerosis in youth. Arterioscler Thromb Vasc Biol. 2000. 20:1998–2004.
9. Tuzcu EM, Kapadia SR, Tutar E, et al. High prevalence of coronary atherosclerosis in asymptomatic teenagers and young adults: evidence from intravascular ultrasound. Circulation. 2001. 103:2705–2710.
10. Skilton MR. Intrauterine risk factors for precocious atherosclerosis. Pediatrics. 2008. 121:570–574.
11. Urbina EM, Williams RV, Alpert BS, et al. Noninvasive assessment of subclinical atherosclerosis in children and adolescents: recommendations for standard assessment for clinical research: a scientific statement from the American Heart Association. Hypertension. 2009. 54:919–950.
12. Gaeta G, De Michele M, Cuomo S, et al. Arterial abnormalities in the offspring of patients with premature myocardial infarction. N Engl J Med. 2000. 343:840–846.
13. Deng YB, Li TL, Xiang HJ, Chang Q, Li CL. Impaired endothelial function in the brachial artery after Kawasaki disease and the effects of intravenous administration of vitamin C. Pediatr Infect Dis J. 2003. 22:34–39.
14. Noto N, Okada T, Karasawa K, et al. Age-related acceleration of endothelial dysfunction, and subclinical atherosclerosis in subjects with coronary artery lesions after Kawasaki disease. Pediatr Cardiol. 2009. 30:262–268.
15. Davis PH, Dawson JD, Riley WA, Lauer RM. Carotid intimalmedial thickness is related to cardiovascular risk factors measured from childhood through middle age: the Muscatine Study. Circulation. 2001. 104:2815–2819.
16. Li S, Chen W, Srinivasan SR, et al. Childhood cardiovascular risk factors and carotid vascular changes in adulthood: the Bogalusa Heart Study. JAMA. 2003. 290:2271–2276.
17. Raitakari OT, Juonala M, Kahonen M, et al. Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study. JAMA. 2003. 290:2277–2283.
18. Barra S, Giovanni G, Cuomo S, et al. Early increase of carotid intima-media thickness in children with parental history of premature myocardial infarction. Heart. 2009. 95:642–645.
19. Koklu E, Kurtoglu S, Akcakus M, Yikilmaz A, Coskun A, Gunes T. Intima-media thickness of the abdominal aorta of neonate with different gestational ages. J Clin Ultrasound. 2007. 35:491–497.
20. Skilton MR, Evans N, Griffiths KA, Harmer JA, Celermajer DS. Aortic wall thickness in newborns with intrauterine growth restriction. Lancet. 2005. 365:1484–1486.
21. Gunes T, Koklu E, Yikilmaz A, et al. Influence of maternal smoking on neonatal aortic intima-media thickness, serum IGF-I and IGFBP-3 levels. Eur J Pediatr. 2007. 166:1039–1044.
22. Järvisalo MJ, Jartti L, Näntö-Salonen K, et al. Increased aortic intima-media thickness: a marker of preclinical atherosclerosis in high-risk children. Circulation. 2001. 104:2943–2947.
23. Osika W, Dangardt F, Gronros J, et al. Increasing peripheral artery intima thickness from childhood to seniority. Arterioscler Thromb Vasc Biol. 2007. 27:671–676.
24. Kang MI, Kim WS, Kwon TG, Hyun DW, Bae JH. The serum lipid level is associated with intimal thickness of the carotid atery for patients with coronary atherosclerosis. Korean Circ J. 2007. 37:380–384.
25. Li S, Chen W, Srinivasan SR, Berenson GS. Childhood blood pressure as a predictor of arterial stiffness in young adults: the Bogalusa Heart Study. Hypertension. 2004. 43:541–546.
26. Im JA, Lee JW, Shim JY, Lee HR, Lee DC. Association between brachial-ankle pulse wave velocity and cardiovascular risk factors in healthy adolescents. J Pediatr. 2007. 150:247–251.
27. Alpert BS, Collins RT. Assessment of vascular function: pulse wave velocity. J Pediatr. 2007. 150:219–220.
28. Sosnovik DE, Nahrendorf M, Weissleder R. Molecular magnetic resonance imaging in cardiovascular medicine. Circulation. 2007. 115:2076–2086.
29. Morrison JA, Friedman LA, Gray-McGuire C. Metabolic syndrome in childhood predicts adult cardiovascular disease 25 years later: the Princeton Lipid Research Clinics Follow-up Study. Pediatrics. 2007. 120:340–345.
30. National Cholesterol Education Program (NCEP). Highlights for the report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents. Pediatrics. 1992. 89:495–501.
31. Jolliffe CJ, Janssen I. Distribution of lipoproteins by age and gender in adolescents. Circulation. 2006. 114:1056–1062.
32. Magnussen CG, Venn A, Thomson R, et al. The association of pediatric low- and high-density lipoprotein cholesterol dyslipidemia classifications and change in dyslipidemia status with carotid intima-media thickness in adulthood evidence from the cardiovascular risk in Young Finns Study, the Bogalusa Heart Study, and the CDAH (Childhood Determinants of Adult Health) Study. J Am Coll Cardiol. 2009. 53:860–869.
33. Frontin MG, Srinivasan SR, Xu J, Tang R, Bond MG, Berenson GS. Usefulness of childhood non-high density lipoprotein cholesterol levels versus other lipoprotein measures in predicting adult subclinical atherosclerosis: the Bogalusa Heart Study. Pediatrics. 2008. 121:924–929.
34. Lloyd-Jones DM, Nam BH, D'Agostino RB Sr, et al. Parental cardiovascular disease as a risk factor for cardiovascular disease in middle-aged adults: a prospective study of parents and offspring. JAMA. 2004. 291:2204–2211.
35. Cuomo S, Guarini P, Gaeta G, et al. Increased carotid intimamedia thickness in children-adolescents, and young adults with a parental history of premature myocardial infarction. Eur Heart J. 2002. 23:1345–1350.
36. McGill HC Jr, McMahan CA, Zieske AW, Malcom GT, Tracy RE, Strong JP. Effects of nonlipid risk factors on atherosclerosis in youth with a favorable lipoprotein profile. Circulation. 2001. 103:1546–1550.
37. Ambrose JA, Barua RS. The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol. 2004. 43:1731–1737.
38. McGill HC Jr, McMahan CA, Malcom GT, Oalmann MC, Strong JP. Relation of glycohemoglobin and adiposity to atherosclerosis in youth. Arterioscler Thromb Vasc Biol. 1995. 15:431–440.
39. Järvisalo MJ, Putto-Laurila A, Jartti L, et al. Carotid artery intima-media thickness in children with type 1 diabetes. Diabetes. 2002. 51:493–498.
40. Kavey RE, Allada V, Daniels SR, et al. Cardiovascular risk reduction in high-risk pediatric patients: a scientific statement from the American Heart Association Expert Panel on Population and Prevention Science; the Councils on Cardiovascular Disease in the Young, Epidemiology and Prevention, Nutrition, Physical Activity and Metabolism, High Blood Pressure Research, Cardiovascular Nursing, and the Kidney in Heart Disease; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation. 2006. 114:2710–2738.
41. American Academy of Pediatrics. Cardiovascular risk reduction in high-risk pediatric populations. Pediatrics. 2007. 119:618–621.
42. McMahan CA, Gidding SS, Fayad ZA, et al. Risk scores predict atherosclerotic lesions in young people. Arch Intern Med. 2005. 165:883–890.
43. McMahan CA, Gidding SS, Malcom GT, Tracy RE, Strong JP, McGill HC Jr. Pathobiological determinants of atherosclerosis in youth risk scores are associated with early and advanced atherosclerosis. Pediatrics. 2006. 118:1447–1455.
44. Gidding SS, McMahan CA, McGill , et al. Prediction of coronary artery calcium in young adults using the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) risk score. Arch Intern Med. 2006. 166:2341–2347.
45. Kavey RE, Daniels SR, Lauer RM, Atkins DL, Hayman LL, Taubert K. American Heart Associaion guidelines for primary prevention of atherosclerotic cardiovascular disease beginning in childhood. Circulation. 2003. 107:1562–1566.
46. Gidding SS, Lichtenstein AH, Faith MS, et al. Implementing American Heart Association Pediatric and Adult Nutrition Guidelines. A Scientific Statement From the American Heart Association Nutrition Committee of the Council on Nutrition, Physical Activity and Metabolism, Council on Cardiovascular Disease in the Young, Council on Arteriosclerosis, Thrombosis and Vascular Biology, Council on Cardiovascular Nursing, Council on Epidemiology and Prevention, and Council for High Blood Pressure Research. Circulation. 2009. 119:1161–1175.
47. McGill HC Jr, McMahan CA, Gidding SS. Preventing heart disease in the 21st century: implications of the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Study. Circulation. 2008. 117:1216–1227.
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