Intima media thickness-related risk factors in childhood obesity

Macroangiopathy caused by atherosclerosis is one of the major morbidity and mortality factors in obese adults with dyslipidemia, hypertension and disturbed glucose metabolism. However, the onset of these cardiovascular changes is not well established. Measuring the intima-media thickness (IMT) of the common carotid artery, as a non-invasive marker for early atherosclerotic changes, has been reported to be reliable and predictive for later cardiovascular disease. Increased IMT has been reported in children with diabetes mellitus type 1 and 2. IMT was related to both hyperglycaemia and dyslipidemia in these children. Furthermore, children with hypertension demonstrated increased IMT. Moreover, children with familial hypercholesterolemia have higher IMT values as compared to healthy children. Obese children with the features of the metabolic syndrome (MetS) such as hypertension, dyslipidemia, or impaired glucose tolerance also demonstrated increased IMT. A strong association between IMT and parameters of the MetS has been reported for impaired glucose tolerance. Furthermore, increased androgens in girls with polycystic ovarian syndrome (PCOS) are associated with increased IMT measurements. Reduction of overweight and normalization of blood pressure, glucose metabolism and dyslipidemia were associated with a reduction of IMT in children and adolescents. In conclusion, early vascular changes already occur in obese children with MetS suggesting that rather cardiovascular risk factors such as hypertension, dyslipidaemia, or disturbed glucose metabolism are associated to increased IMT than obesity per se. Most importantly, these early changes are reversible if effective therapy of cardiovascular risk factors could be achieved.