Assessment of “Vascular Age” in Children

Joseph Le*Spencer Menees*

Dr. David McCrary, MD†*Danna Zhang, MS∆Dr. Jie Chen, PhD∆

Dr. Geetha Raghuveer, MD MPH†*

†Children’s Mercy Hospital – Dept of Cardiology*University of Missouri-Kansas City School of Medicine

∆University of Missouri-Kansas City Volker Campus

No conflict of interest

“A man is as old as his arteries.”

-Dr. Thomas Sydenham

Background

Over 25% of children in the United States are obeseObese children are at greater risk for dyslipidemia,

diabetes, hypertension, and premature atherosclerosisCoronary artery disease is the most common reason for

death in men and women over 20 years of age

Aim

To delineate if children with obesity and dyslipidemia had premature aging of their arteries

Children were referred to Preventive Cardiology Clinic at Children’s Mercy Hospital for:

DyslipidemiaObesity & DyslipidemiaFamily history of premature cardiac death

Study Population

Methods“Vascular age” was evaluated by comparing the

child’s arteries against that of a race and sex matched 45 year old

“Vascular age” was determined by measuring the carotid artery intima-media thickness (CIMT) using vascular ultrasound (Philips) and a high-resolution linear array vascular probe

CIMT was plotted against standard tables that have been published for the adult population to determine the child’s vascular age

Carotid Artery UltrasoundNeck Ultrasound Probe

Carotid Artery UltrasoundThe far wall of the common carotid artery 2 cm

proximal to the bifurcation was scanned for measurements of CIMT

The clips acquired from both the left and right common carotid arteries were analyzed using a semi-automated edge detection software (QLAB)

Each study consisted measuring CIMT on an average of 100 frames

CIMT measurements were tabulated in an excel spreadsheet and the grand mean CIMT and maximum CIMT were derived

Carotid Artery Ultrasound (12 yo white male)

White Men

Percentile 45 yo 55 yo 65 yo

P05 0.40 0.45 0.50

P10 0.44 0.49 0.56

P25 0.50 0.57 0.65

P50 0.57 0.66 0.76

P75 0.66 0.77 0.90

P90 0.75 0.88 1.07

P95 0.83 0.96 1.25

RCCA CIMT (mm)(12 yo white male)

CIMT

CIMT Value

Mean (mm) 0.45 ± 0.03

Median (mm) 0.44 (0.41-0.54)

Maximum (mm) 0.75

(n=70)

RaceRace Number Percentage

White 62 88.6%

Black 8 11.4%

0%10%20%30%40%50%60%70%80%90%100%

White Black

(n=70)

SexSex Number Percentage

Male 34 48.6%

Female 36 51.4%

0%10%20%30%40%50%60%70%80%90%100%

Male Female

(n=70)

Demographics

Vitals Mean ± SD

Age (years) 13.0 ± 3.3

Weight (kg) 64.0 ± 23.4

Body Mass Index (kg/m2) 25.6 ± 6.0 (40/70 > 95th percentile)

(n=70)

Lipid Profile

Lipids Mean ± SD Optimal Levels

Total Cholesterol (mg/dL) 223.4 ± 57.5* <170

LDL (mg/dL) 149.8 ± 59.0* <110

HDL (mg/dL) 46.3 ± 13.4 >35

Triglycerides (mg/dL) 151.9 ± 105.4* <100

(n=70)

*=abnormal levels

Abnormal Lipid Profiles

Lipids n

Total Cholesterol > 170 59

LDL > 110 51

HDL < 35 17

Triglycerides > 100 43

(n=70)

Vascular AgeVascular Age Number Percentage

>25 52 74.3%

<25 18 25.7%

0%10%20%30%40%50%60%70%80%90%100%

>25 <25

(n=70)

>25th<25th

0.6

0.5

0.4

0.3

0.2

0.1

0.0

Vascular Age

CIM

T

<25th>25th

AgeVascular

0.545385

0.48

Vascular Age vs CIMT

>0.06 mm difference

>25th<25th

180

160

140

120

100

80

60

40

20

0

Vascular Age

Trig

lyce

rides

<25th>25th

AgeVascular

166.442

109.778

Vascular Age vs Triglycerides

Vascular Age and Triglyceridesn=70, Trig cutoff 100, p=0.00

Vascular Age and TriglyceridesBMI > 95th percentile

n=40, Trig cutoff 100, p=0.01

Multivariate Analysis(predictors of CIMT)

Age

Body Mass Index

HDL cholesterol

r2 =0.67

ConclusionVascular age is advanced in children with risk

factors such as obesity and dyslipidemiaCarotid artery ultrasound and estimation of vascular

age may help further stratify children with risk factors who may be at greater risk for premature atherosclerosis

These children may need intensive management including pharmacotherapy for risk factor modification

Future Direction

Further studies to assess the impact of risk factor modification on vascular age