April 29, 2009 – Based on research presented at the 58th annual ACC Scientific Session, children with elevated levels of triglycerides may be at increased risk of cardiovascular disease (CVD) events in early adulthood, and as a result, pediatricians are encouraged to look at a child’s full lipid panel.
This finding is based on a 25 to 30 year follow-up study of 808 out of 1,756 subjects, first evaluated as school children between 1973 and 1976. Researchers restudied eligible participants to compare childhood and adult CVD risk factors in those who did and did not develop CVD in their 30s and 40s. Of these, 19 reported cardiovascular events as adults, the most common being heart attacks, angioplasties to re-open clogged coronary arteries, and bypass surgeries.
“Pediatric triglycerides are an exceptionally strong, independent predictor of early onset cardiovascular events,” said John Morrison, Ph.D., professor emeritus of Preventive Cardiology,Cincinnati Children’s Hospital. “Those who developed cardiovascular disease events tended to have higher levels of triglycerides and were more likely to be overweight or obese in childhood.”
Compared to the 789 CVD-free controls, participants who developed CVD had higher average childhood triglyceride (127 vs. 76 mg/dl, p
In multivariate analyses, those with a history of CVD were also significantly more likely to abuse tobacco, be overweight or obese (BMI 33.2 vs. 28.6, p =.0078), live with diabetes, and have elevated triglycerides (251 vs. 135 mg/dl, p =.0016) and blood sugar (122 vs. 90 mg/dl, p =.0001) as adults compared to the CVD-free group. These risk factor differences remained significant even after adjusting for adult age, sex and race. Normal triglyceride levels are less than 150 mg/dl.
Participants’ blood was drawn at hospitals in their area and sent overnight to Cincinnati Children’s Hospital. Comparisons of the original childhood data between participants and nonparticipants (those who were not followed) indicated that participants had higher BMI as children (p = 0.004). After adjusting for age, sex and BMI, differences in total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride levels between the participants and non-participants in childhood were not significant, indicating those who were followed did not differ from those who were not followed with respect to lipid profile.
Although there were few cases of CVD in this young study group, the data suggest pediatric triglycerides and obesity play a role in the development of early CVD.
"In the last decade, we have started to appreciate more the role of triglyceride-rich remnant particles in cardiovascular risk, and how they can accelerate the formation of lipid deposits in the arteries," Morrison said.
"While lowering LDL-cholesterol levels remains a primary therapeutic target, pediatric triglycerides and obesity, as well as smoking and early onset type 2 diabetes, remain serious risk factors for early CVD," said Samrat Yeramaneni, M.D., clinical research associate, Jewish Hospital Cholesterol Center. "Based on our findings, we encourage pediatricians and family practitioners to take notice of elevated levels of triglycerides, which are a part of standard lipid profiles, and screen for overweight and obesity as indicators of future risk of CVD and initiate early interventions."
The baseline and follow-up studies were funded by the National Heart Lung and Blood Institute of the National Institutes of Health.
For more information: www.acc.org
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