Ximena Berríos

Adiponectin levels, cardiometabolic risk factors and markers of subclinical atherosclerosis in children

BACKGROUND Low levels of adiponectin have been associated with metabolic risk factors (RF) and cardiac disease. Minimal data is available about the relationship between adiponectin and subclinical atherosclerosis. OBJECTIVES To determine the relationship of adiponectin to cardiometabolic RF, C-reactive protein (CRP), anthropometric parameters of obesity, and subclinical atherosclerosis in children. METHODS Cross-sectional study in 103 children. We determined body mass index (BMI), waist circumference, percent fat mass, systolic and diastolic blood pressures, fasting lipid profile, glycemia and insulinemia, and CRP. Subclinical atherosclerosis was determined by carotid intima-media thickness (IMT) and flow-mediated dilation of the brachial artery (FMD). RESULTS Mean age of the group was 12.4+/-1.9 years (47% girls; 20.4% prepubertal; 45 eutrophic, 23 overweight and 35 obese). Adiponectin levels were not statistically significantly different in eutrophic children versus obese+overweight: 17.7+/-5.6 and 15.9+/-5.3 microg/mL, respectively. Adiponectin levels in boys were no different from those in girls. Adiponectin correlated significantly with age, BMI, zBMI, waist circumference, systolic and diastolic blood pressures, HDL, insulinemia, and HOMA index. No statistically significant association with adiponectin was found for CRP, FMD or IMT. After adjusting by sex, pubertal status, and degree of obesity, the adiponectin levels associated significantly with HDL cholesterol and the HOMA index (r(2)=0.34, p<0.0001). CONCLUSIONS Adiponectin levels were inversely correlated with anthropometric parameters of obesity and insulin resistance and directly correlated with HDL levels. However, no relationship with subclinical atherosclerosis was demonstrated in this study.

Marcadores de aterosclerosis temprana y síndrome metabólico en niños

Background: The high prevalence of obesity in children favors the appearance of metabolic syndrome (MS), increasing their cardiovascular risk. Aim: To evaluate components of MS in children and to correlate them with surrogate markers of atherosclerosis and subclinical inflammation. Material and methods: We studied 209 children aged 11.5 ± 2 years (50% girls, 30% prepuberal). Fifty percent had normal weight, 18% were overweight, 29% were obese and 3% were undernourished. A fasting blood sample was obtained to measure lipid levels, glucose, insulin, adiponectin and ultrasensitive C-reactive protein (usCRP). Subclinical atherosclerosis was evaluated using flow mediated dilatation of brachial artery (FMD) and carotid intima-media thicknes (IMT). For diagnosis of MS we adapted Cook’s criteria. Results: Five percent of all children and 18% of those with overweight had MS. Children with more components had significantly higher fasting insulin and Homeostasis Model Assessment (HOMA) values. Clustering of MS components was also associated to higher values of usCRP and non significantly to lower adiponectin levels. We did not find differences in FMD. In obese children there was a tendency towards a higher IMT with clustering of MS components, although not significant. Conclusions: Children with overweight presented a higher risk of a clustering of MS components, which was also associated with insulin resistance and increase in ultrasensitive C reactive protein (Rev Med Chile 2009; 137: 522-30). (Key words: Atherosclerosis; Child; Metabolic syndrome)

Relación colesterol total a HDL y colesterol no HDL: los mejores indicadores lipídicos de aumento de grosor de la íntima media carotidea

BACKGROUND LDL, HDL cholesterol and triglycerides, are the most commonly used lipid cardiovascular risk predictor indicators. However population based studies have shown that non-HDL cholesterol and total/HDL cholesterol ratio are better predictors, are easy to measure and do not require fasting. AIM To determine which lipid indicators are better determinants of subclinical atherosclerosis, measured by intima media thickness (IMT) among subjects without demonstrated atherosclerosis. MATERIAL AND METHODS Lipid profile, height, weight, blood pressure and bilateral IMT, measured by ultrasound with automatic border recognition software, were assessed in 770 men and 854 women aged 45 ± 11 years, in Santiago de Chile. RESULTS Mean total cholesterol was 202, HDL 50, LDL 121, triglycerides 157 and non-HDL cholesterol 152 mg/dl. Total/HDL cholesterol ratio was 4.3. Mean IMT was 0.62 mm. All lipid markers were significantly correlated with IMT. This correlation was higher for non-HDL cholesterol (r = 0.24, p < 0.0001) and total/HDL cholesterol ratio(r = 0.23, p < 0.0001). In both men and women, total/HDL cholesterol ratio was the best predictor of having an IMT over the 75th percentile (odds ratio 1.21, 95% confidence intervals 1.09-1.35, p < 0.01). CONCLUSIONS Total/HDL cholesterol ratio was the best determinant of subclinical atherosclerosis.

Hipertensión arterial: el factor de riesgo más importante para grosor íntima-media carotídeo elevado y placa carotídea en adultos de Santiago

BACKGROUND Carotid intima media thickness (CIMT) is a marker of cardiovascular damage that can be modified by traditional risk factors. AIM To determine attributable risk factors for a high CIMT among healthy adults. MATERIAL AND METHODS A sample of 1270 individuals (636 males and 634 females) aged 44 ± 11 years, was studied. Blood pressure, weight, height, lipid profile and blood glucose were measured in all. CIMT and the presence of atherosclerotic plaques were determined by carotid ultrasound. Standard criteria were used to define hypertension, dyslipidemia and diabetes. RESULTS Mean CIMT in the sample studied was 0.62 ± 0.01 mm and percentile 75 was 0.67. The most important risk factor for a CIMT over percentile 75 and the presence of atherosclerotic plaques was hypertension with attributable risks of 54 and 57%, respectively. CONCLUSIONS In this sample, the main risk factor for a high CIMT was hypertension.

Perfil de riesgo cardiovascular en adultos jóvenes asintomáticos con grosor íntima media carotídeo elevado

BACKGROUND Cardiovascular risk factor (RF) assessment is essential to prevent and predict cardiovascular disease. The presence of RF at early ages, are determinant for the presence of atherosclerosis later in life. AIM To determine the RF profile of young subjects with high carotid intima media thickness (CIMT). MATERIAL AND METHODS We studied 689 subjects (50% women, mean age 36±6 years) from Santiago, Chile. We determined body mass index (BMI), waist circumference, blood pressure, fasting serum lipids, blood glucose and C-reactive protein. CIMT was assessed by ultrasound using an automatic border recognition software. RESULTS Body mass index, waist circumference, blood pressure and serum lipids were significantly higher among subjects located in the higher CIMT quartile. Also, subjects in the higher quartile of CIMT had a higher prevalence of three or more RF compared with the lower quartile (p = 0.01). Finally, individuals with three or more RF showed three times more risk of being in the higher CIMT quartile, than subjects with no RF (odds ratio = 3.1, p < 0.01). CONCLUSIONS There is a negative influence of cardiovascular RF on CIMT among young subjects.

Modificación del grosor intima-media carotídeo según factores de riesgo clásicos y síndrome metabólico con o sin inflamación

Resumen El grosor intima-media carotideo (CIMT) es un marcador de aterosclerosis subclinica y eventos isquemicoscerebrales y coronarios. Si bien los valores normales promedio en Chile, han sido publicados, no existendatos locales de como se modifica el CIMT segun la carga de factores de riesgo (FR) cardiovascular. Objetivos: Analizar la modificacion del CIMT segun la carga de FR clasicos, presencia de sindrome metabolico(SMET) y SMET mas inflamacion. Metodos: Hombres y mujeres de Santiago sin antecedente de eventos isquemicos previos, nivel socio economicomedio, medio bajo y medio alto. En todos se realizo encuesta sobre antecedentes demograficos, FRcardiovascular, y medicion de PA, IMC, cintura, y perfil lipidico, glicemia y proteina C-reactiva ultrasensible(ePCR) en ayuno. Para diagnostico de SMET se uso NCEP ATPIII (2001), y para inflamacion, ePCR> 2 mg/L(valor de corte de > riesgo por AHA). El CIMT se midio en carotida comun derecha e izquierda con software MATH ® . Resultados:

Sirven los marcadores de riesgo no tradicionales en la diferenciación del riesgo cardiovascular en adultos jóvenes con exceso de peso

BACKGROUND Recognizing cardiovascular risk in overweight adults is challenging, as they usually have a low Framingham risk score (FRAM). In these subjects, non-traditional biomarkers could improve risk stratification. AIM To assess carotid intima media thickness (CIMT) and ultrasensitive C-reactive protein (usCRP) among overweight and obese subjects without metabolic syndrome (MetSyn). SUBJECTS AND METHODS In 1558 asymptomatic participants (816 women, 45 ± 11 years) we measured body mass index (BMI), waist circumference, blood pressure, lipid profile, blood glucose, FRAM, usCRP and CIMT. For analytical purposes, we divided the subjects in three groups according to BMI and number of ATPIII-MetSyn risk factors (RF): 1) BMI < 25 and < 3RF, 2) BMI ≥ 25 and < 3RF and 3) BMI ≥ 25 and ≥ 3RF. RESULTS Participants of group 2 (BMI ≥ 25 and < 3RF) had a low FRAM (8%). Compared with participants of group 1, they had a higher CIMT (0.61 ± 0.1 and 0.57 ± 0.09 mm, respectively, p < 0.01) and usCRP (2.1 ± 2.1 and 1.5 ± 1.9 mg/L respectively, p < 0.01). CONCLUSIONS This study shows that although subjects with overweight/obesity without MetSyn have low cardiovascular risk based on FRAM, they have higher CIMT and usCRP than their normal weight counterparts.