Managing Cardiovascular Risk in Overweight Children and Adolescents

Abstract

The scientific, medical, and lay communities are currently confronted with a serious medical and public health problem related to the marked non-remitting worldwide epidemic of obesity. This ever-increasing prevalence of obesity is accompanied by a host of inherently associated co-morbidities. As a result, obesity is fast becoming the major cause of premature death in the developed world. As pediatric and adult cardiologists, we have seen a dramatic increase in office referrals of overweight and obese children and adolescents, who already have obesity-related degenerative disease processes such as hypertension, dyslipidemia, the metabolic syndrome, and type 2 diabetes mellitus, as well as manifestations of early preclinical atherosclerotic cardiovascular disease, not previously observed in this age group. This article presents a review of the literature and recent scientific statements and recommendations issued by the American Heart Association (AHA) and the American Academy of Pediatrics (AAP) regarding the metabolic abnormalities associated with obesity, including newer identification and treatment strategies for obesity, dyslipidemia, and early subclinical coronary artery disease seen in high-risk children and adolescents.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. 1.

    Sturm R. Increases in clinically severe obesity in the United States, 1986–2000. Arch Intern Med. 2003;163(18):2146–8.

    PubMed  Article  Google Scholar 

  2. 2.

    Ogden CL, Flegal KM, Carroll MD, et al. Prevalence and trends in overweight among US children and adolescents, 1999–2000. JAMA. 2002;288(14):1728–32.

    PubMed  Article  Google Scholar 

  3. 3.

    Troiano RP, Flegal KM. Overweight children and adolescents: description, epidemiology, and demographics. Pediatrics. 1998;101(3 Pt 2):497–504.

    PubMed  CAS  Google Scholar 

  4. 4.

    Whitaker RC, Wright JA, Pepe MS, et al. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med. 1997;337(13):869–73.

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Gordon-Larsen P, Adair LS, Nelson MC, et al. Five-year obesity incidence in the transition period between adolescence and adulthood: the National Longitudinal Study of Adolescent Health. Am J Clin Nutr. 2004;80(3):569–75.

    PubMed  CAS  Google Scholar 

  6. 6.

    Thompson D, Brown JB, Nichols GA, et al. Body mass index and future healthcare costs: a retrospective cohort study. Obes Res. 2001;9(3):210–8.

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Daniels SR. Obesity in the pediatric patient: cardiovascular complications. Prog Pediatr Cardiol. 2001;12(2):161–7.

    PubMed  Article  Google Scholar 

  8. 8.

    Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP). Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001;285(19):2486–97.

    Google Scholar 

  9. 9.

    Skilton MR, Moulin P, Sérusclat A, et al. A comparison of the NCEP-ATPIII, IDF and AHA/NHLBI metabolic syndrome definitions with relation to early carotid atherosclerosis in subjects with hypercholesterolemia or at risk of CVD: evidence for sex-specific differences. Atherosclerosis. 2007;190(2):416–22.

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112(17):2735–52.

    PubMed  Article  Google Scholar 

  11. 11.

    Cheal KL, Abbasi F, Lamendola C, et al. Relationship to insulin resistance of the adult treatment panel III diagnostic criteria for identification of the metabolic syndrome. Diabetes. 2004;53(5):1195–200.

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Grundy SM, Hansen B, Smith SC Jr, et al. Clinical management of metabolic syndrome: report of the American Heart Association/National Heart, Lung, and Blood Institute/American Diabetes Association conference on scientific issues related to management. Circulation. 2004;109(4):551–6.

    PubMed  Article  Google Scholar 

  13. 13.

    Ten S, Maclaren N. Insulin resistance syndrome in children. J Clin Endocrinol Metab. 2004;89(6):2526–39.

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes. 1988;37(12):1595–607.

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Hoffman RP, Stumbo PJ, Janz KF, et al. Altered insulin resistance is associated with increased dietary weight loss in obese children. Horm Res. 1995;44(1):17–22.

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Freemark M, Bursey D. The effects of metformin on body mass index and glucose tolerance in obese adolescents with fasting hyperinsulinemia and a family history of type 2 diabetes. Pediatrics. 2001;107(4):E55.

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Freemark M. Pharmacologic approaches to the prevention of type 2 diabetes in high risk pediatric patients. J Clin Endocrinol Metab. 2003;88(1):3–13.

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Park MH, Kinra S, Ward KJ, et al. Metformin for obesity in children and adolescents: a systematic review. Diabetes Care. 2009;32(9):1743–5.

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Atabek ME, Pirgon O. Use of metformin in obese adolescents with hyperinsulinemia: a 6-month, randomized, double-blind, placebo-controlled clinical trial. J Pediatr Endocrinol Metab. 2008;21(4):339–48.

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Cerner Multum I. Glucophage [online]. Available from URL: http://www.drugs.com/mtm/glucophage.html. [Accessed 2012 Mar 27].

  21. 21.

    Howard BV, Ruotolo G, Robbins DC. Obesity and dyslipidemia. Endocrinol Metab Clin North Am. 2003;32(4):855–67.

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Daniels SR, Greer FR. Lipid screening and cardiovascular health in childhood. Pediatrics. 2008;122(1):198–208.

    PubMed  Article  Google Scholar 

  23. 23.

    No authors listed. National Cholesterol Education Program (NCEP): highlights of the report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents. Pediatrics. 1992;89(3):495–501.

    Google Scholar 

  24. 24.

    Ross SD, Allen IE, Connelly JE, et al. Clinical outcomes in statin treatment trials: a meta-analysis. Arch Intern Med. 1999;159(15):1793–802.

    Google Scholar 

  25. 25.

    Staels B, Fonseca VA. Bile acids and metabolic regulation: mechanisms and clinical responses to bile acid sequestration. Diabetes Care. 2009;32(Suppl. 2):S237–45.

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Robbins DA. The safety and efficacy of statin therapy in the pediatric population. J Cardiovasc Nurs. 2011;26(1):44–52.

    Google Scholar 

  27. 27.

    Rosenson RS, Tangney CC. Antiatherothrombotic properties of statins: implications for cardiovascular event reduction. JAMA. 1998;279(20):1643–50.

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Colletti RB, Neufeld EJ, Roff NK, et al. Niacin treatment of hypercholesterolemia in children. Pediatrics. 1993;92(1):78–82.

    PubMed  CAS  Google Scholar 

  29. 29.

    Toth PP. Drug treatment of hyperlipidaemia: a guide to the rational use of lipid-lowering drugs. Drugs. 2010;70(11):1363–79.

    PubMed  Article  CAS  Google Scholar 

  30. 30.

    Din JN, Newby DE, Flapan AD. Omega 3 fatty acids and cardiovascular disease: fishing for a natural treatment. BMJ. 2004;328(7430):30–5.

    PubMed  Article  CAS  Google Scholar 

  31. 31.

    Dujovne CA, Ettinger MP, McNeer JF, et al. Efficacy and safety of a potent new selective cholesterol absorption inhibitor, ezetimibe, in patients with primary hypercholesterolemia. Am J Cardiol. 2002;90(10):1092–7.

    PubMed  Article  CAS  Google Scholar 

  32. 32.

    Sorof J, Daniels S. Obesity hypertension in children: a problem of epidemic proportions. Hypertension. 2002;40(4):441–7.

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Peco-Antić A. Hypertension in obese children and adolescents. Srp Arh Celok Lek. 2009;137(1–2):91–7.

    Google Scholar 

  34. 34.

    Burke V, Beilin LJ, Dunbar D. Tracking of blood pressure in Australian children. J Hypertens. 2001;19(7):1185–92.

    PubMed  Article  CAS  Google Scholar 

  35. 35.

    Clarke WR, Woolson RF, Lauer RM. Changes in ponderosity and blood pressure in childhood: the Muscatine Study. Am J Epidemiol. 1986;124(2):195–206.

    PubMed  CAS  Google Scholar 

  36. 36.

    Wofford MR, Hall JE. Pathophysiology and treatment of obesity hypertension. Curr Pharm Des. 2004;10(29):3621–37.

    PubMed  Article  CAS  Google Scholar 

  37. 37.

    Yusuf HR, Giles WH, Croft JB, et al. Impact of multiple risk factor profiles on determining cardiovascular disease risk. Prev Med. 1998;27(1):1–9.

    Google Scholar 

  38. 38.

    Kavey RE, Daniels SR, Lauer RM, et al. American Heart Association guidelines for primary prevention of atherosclerotic cardiovascular disease beginning in childhood. Circulation. 2003;107(11):1562–6.

    PubMed  Article  Google Scholar 

  39. 39.

    ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288(23):2981–97.

    Article  Google Scholar 

  40. 40.

    Sakarcan A, Tenney F, Wilson JT, et al. The pharmacokinetics of irbesartan in hypertensive children and adolescents. J Clin Pharmacol. 2001;41(7):742–9.

    PubMed  Article  CAS  Google Scholar 

  41. 41.

    Soffer B, Zhang Z, Miller K, et al. A double-blind, placebo-controlled, dose-response study of the effectiveness and safety of lisinopril for children with hypertension. Am J Hypertens. 2003;16(10):795–800.

    PubMed  Article  CAS  Google Scholar 

  42. 42.

    Sorof JM, Cargo P, Graepel J, et al. Beta-blocker/thiazide combination for treatment of hypertensive children: a randomized double-blind, placebo-controlled trial. Pediatr Nephrol. 2002;17(5):345–50.

    PubMed  Article  Google Scholar 

  43. 43.

    Trachtman H, Frank R, Mahan JD, et al. Clinical trial of extended-release felodipine in pediatric essential hypertension. Pediatr Nephrol. 2003;18(6):548–53.

    PubMed  Google Scholar 

  44. 44.

    Wells TG. Trials of antihypertensive therapies in children. Blood Press Monit. 1999;4(3–4):189–92.

    Google Scholar 

  45. 45.

    Lüscher TF, Wenzel RR, Moreau P, et al. Vascular protective effects of ACE inhibitors and calcium antagonists: theoretical basis for a combination therapy in hypertension and other cardiovascular diseases. Cardiovasc Drugs Ther. 1995;9(Suppl. 3):509–23.

    PubMed  Article  Google Scholar 

  46. 46.

    Schiffrin EL. Remodeling of resistance arteries in human hypertension: effects of cilazapril, an angiotensin-I-converting enzyme inhibitor. Cardiology. 1995;86(Suppl. 1):16–22.

    PubMed  Article  Google Scholar 

  47. 47.

    Park JB, Intengan HD, Schiffrin EL. Reduction of resistance artery stiffness by treatment with the AT(1)-receptor antagonist losartan in essential hypertension. J Renin Angiotensin Aldosterone Syst. 2000;1(1):40–5.

    PubMed  Article  CAS  Google Scholar 

  48. 48.

    Hanevold C, Waller J, Daniels S, et al. The effects of obesity, gender, and ethnic group on left ventricular hypertrophy and geometry in hypertensive children: a collaborative study of the International Pediatric Hypertension Association. Pediatrics. 2004;113(2):328–33.

    PubMed  Article  Google Scholar 

  49. 49.

    National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(2 Suppl. 4th Report):555–76.

    Google Scholar 

  50. 50.

    Dandona P, Aljada A, Chaudhuri A, et al. Metabolic syndrome: a comprehensive perspective based on interactions between obesity, diabetes, and inflammation. Circulation. 2005;111(11):1448–54.

    PubMed  Article  Google Scholar 

  51. 51.

    Singh SK, Suresh MV, Voleti B, et al. The connection between C-reactive protein and atherosclerosis. Ann Med. 2008;40(2):110–20.

    PubMed  Article  CAS  Google Scholar 

  52. 52.

    Heinrich PC, Castell JV, Andus T. Interleukin-6 and the acute phase response. Biochem J. 1990;265(3):621–36.

    PubMed  CAS  Google Scholar 

  53. 53.

    Castell JV, Gómez-Lechón MJ, David M, et al. Interleukin-6 is the major regulator of acute phase protein synthesis in adult human hepatocytes. FEBS Lett. 1989;242(2):237–9.

    PubMed  Article  CAS  Google Scholar 

  54. 54.

    Sacheck J. Pediatric obesity: an inflammatory condition? J Parenter Enteral Nutr. 2008;32(6):633–7.

    Article  CAS  Google Scholar 

  55. 55.

    Ervin RB, Ogden CL. Trends in intake of energy and macronutrients in children and adolescents from 1999–2000 through 2009–2010. NCHS data brief, no 113. Hyattsville (MD): National Center for Health Statistics; 2013.

  56. 56.

    Strauss RS. Comparison of serum concentrations of alpha-tocopherol and beta-carotene in a cross-sectional sample of obese and nonobese children (NHANES III). National Health and Nutrition Examination Survey. J Pediatr. 1999;134(2):160–5.

    PubMed  Article  CAS  Google Scholar 

  57. 57.

    Molnár D, Decsi T, Koletzko B. Reduced antioxidant status in obese children with multimetabolic syndrome. Int J Obes Relat Metab Disord. 2004;28(10):1197–202.

    PubMed  Article  Google Scholar 

  58. 58.

    Alemzadeh R, Kichler J, Babar G, et al. Hypovitaminosis D in obese children and adolescents: relationship with adiposity, insulin sensitivity, ethnicity, and season. Metabolism. 2008;57(2):183–91.

    PubMed  Article  CAS  Google Scholar 

  59. 59.

    Mohn A, Catino M, Capanna R, et al. Increased oxidative stress in prepubertal severely obese children: effect of a dietary restriction-weight loss program. J Clin Endocrinol Metab. 2005;90(5):2653–8.

    PubMed  Article  CAS  Google Scholar 

  60. 60.

    Stanhope KL, Havel PJ. Fructose consumption: considerations for future research on its effects on adipose distribution, lipid metabolism, and insulin sensitivity in humans. J Nutr. 2009;139(6):1236S–41S.

    PubMed  Article  CAS  Google Scholar 

  61. 61.

    Lê KA, Ith M, Kreis R, et al. Fructose overconsumption causes dyslipidemia and ectopic lipid deposition in healthy subjects with and without a family history of type 2 diabetes. Am J Clin Nutr. 2009;89(6):1760–5.

    PubMed  Article  Google Scholar 

  62. 62.

    Johnson RJ, Segal MS, Sautin Y, et al. Potential role of sugar (fructose) in the epidemic of hypertension, obesity and the metabolic syndrome, diabetes, kidney disease, and cardiovascular disease. Am J Clin Nutr. 2007;86(4):899–906.

    PubMed  CAS  Google Scholar 

  63. 63.

    U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th edn. Washington, DC: US Government Printing Office; 2010.

  64. 64.

    Marcus BH, Williams DM, Dubbert PM, et al. Physical activity intervention studies: what we know and what we need to know: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity); Council on Cardiovascular Disease in the Young; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research. Circulation. 2006;114(24):2739–52.

    PubMed  Article  Google Scholar 

  65. 65.

    Barnes PM, Schoenborn CA. Physical activity among adults: United States, 2000. Advance data from vital and health statistics; No. 333. Hyattsville (MD): National Center for Health Statistics; 2003.

  66. 66.

    Center for Disease Control and Prevention. Physical activity levels among children aged 9–13 years: United States, 2002. Morb Mortal Wkly Rep. 2003;52(33):785–8.

    Google Scholar 

  67. 67.

    IOM, Preventing Childhood Obesity: Health in the Balance. Washington, DC: National Academy Press; 2005.

  68. 68.

    Ortega FB, Tresaco B, Ruiz JR, et al. Cardiorespiratory fitness and sedentary activities are associated with adiposity in adolescents. Obesity (Silver Spring). 2007;15(6):1589–99.

    Article  Google Scholar 

  69. 69.

    Watts K, Jones TW, Davis EA, et al. Exercise training in obese children and adolescents: current concepts. Sports Med. 2005;35(5):375–92.

    PubMed  Article  Google Scholar 

  70. 70.

    Braith RW, Stewart KJ. Resistance exercise training: its role in the prevention of cardiovascular disease. Circulation. 2006;113(22):2642–50.

    PubMed  Article  Google Scholar 

  71. 71.

    Ruiz JR, Ortega FB, Warnberg J, et al. Associations of low-grade inflammation with physical activity, fitness and fatness in prepubertal children; the European Youth Heart Study. Int J Obes (Lond). 2007;31(10):1545–51.

    Article  CAS  Google Scholar 

  72. 72.

    Isasi CR, Deckelbaum RJ, Tracy RP, et al. Physical fitness and C-reactive protein level in children and young adults: the Columbia University BioMarkers Study. Pediatrics. 2003;111(2):332–8.

    PubMed  Article  Google Scholar 

  73. 73.

    Brage S, Wedderkopp N, Ekelund U, et al. Features of the metabolic syndrome are associated with objectively measured physical activity and fitness in Danish children: the European Youth Heart Study (EYHS). Diabetes Care. 2004;27(9):2141–8.

    PubMed  Article  Google Scholar 

  74. 74.

    Halle M, Korsten-Reck U, Wolfarth B, et al. Low-grade systemic inflammation in overweight children: impact of physical fitness. Exerc Immunol Rev. 2004;10:66–74.

    PubMed  Google Scholar 

  75. 75.

    Schächinger V, Zeiher AM. Atherosclerosis-associated endothelial dysfunction. Z Kardiol. 2000;89(Suppl. 9):IX/70-4.

    Google Scholar 

  76. 76.

    Steinberg HO, Chaker H, Leaming R, et al. Obesity/insulin resistance is associated with endothelial dysfunction: implications for the syndrome of insulin resistance. J Clin Invest. 1996;97(11):2601–10.

    PubMed  Article  CAS  Google Scholar 

  77. 77.

    Eisenmann JC, DuBose KD, Donnelly JE. Fatness, fitness, and insulin sensitivity among 7- to 9-year-old children. Obesity (Silver Spring). 2007;15(8):2135–44.

    Article  Google Scholar 

  78. 78.

    Ruiz JR, Rizzo NS, Ortega FB, et al. Markers of insulin resistance are associated with fatness and fitness in school-aged children: the European Youth Heart Study. Diabetologia. 2007;50(7):1401–8.

    PubMed  Article  CAS  Google Scholar 

  79. 79.

    Allen DB, Nemeth BA, Clark RR, et al. Fitness is a stronger predictor of fasting insulin levels than fatness in overweight male middle-school children. J Pediatr. 2007;150(4):383–7.

    PubMed  Article  CAS  Google Scholar 

  80. 80.

    Eisenmann JC, Welk GJ, Ihmels M, et al. Fatness, fitness, and cardiovascular disease risk factors in children and adolescents. Med Sci Sports Exerc. 2007;39(8):1251–6.

    PubMed  Article  Google Scholar 

  81. 81.

    Eisenmann JC, Welk GJ, Wickel EE, et al. Combined influence of cardiorespiratory fitness and body mass index on cardiovascular disease risk factors among 8–18 year old youth: the Aerobics Center Longitudinal Study. Int J Pediatr Obes. 2007;2(2):66–72.

    PubMed  Article  Google Scholar 

  82. 82.

    Eisenmann JC, Katzmarzyk PT, Perusse L, et al. Aerobic fitness, body mass index, and CVD risk factors among adolescents: the Québec family study. Int J Obes (Lond). 2005;29(9):1077–83.

    Article  CAS  Google Scholar 

  83. 83.

    Dietz WH, Gortmaker SL. Preventing obesity in children and adolescents. Annu Rev Public Health. 2001;22:337–53.

    PubMed  Article  CAS  Google Scholar 

  84. 84.

    Baranowski T, Cullen KW, Nicklas T, et al. School-based obesity prevention: a blueprint for taming the epidemic. Am J Health Behav. 2002;26(6):486–93.

    Google Scholar 

  85. 85.

    Kahn EB, Ramsey LT, Brownson RC, et al. The effectiveness of interventions to increase physical activity: a systematic review. Am J Prev Med. 2002;22(4 Suppl.):73–107.

    PubMed  Article  Google Scholar 

  86. 86.

    Peterson LR, Herrero P, Schechtman KB, et al. Effect of obesity and insulin resistance on myocardial substrate metabolism and efficiency in young women. Circulation. 2004;109(18):2191–6.

    PubMed  Article  Google Scholar 

  87. 87.

    Dhuper S, Abdullah RA, Weichbrod L, et al. Association of obesity and hypertension with left ventricular geometry and function in children and adolescents. Obesity (Silver Spring). 2011;19(1):128–33.

    Article  Google Scholar 

  88. 88.

    Maeder MT, Kaye DM. Heart failure with normal left ventricular ejection fraction. J Am Coll Cardiol. 2009;53(11):905–18.

    PubMed  Article  Google Scholar 

  89. 89.

    Narkiewicz K, Somers VK. Sympathetic nerve activity in obstructive sleep apnoea. Acta Physiol Scand. 2003;177(3):385–90.

    PubMed  Article  CAS  Google Scholar 

  90. 90.

    Bloomgarden ZT. Obesity: mediators and treatment approaches. Diabetes Care. 2009;32(5):e48–52.

    PubMed  Article  Google Scholar 

  91. 91.

    McGill AT, Stewart JM, Lithander FE, et al. Relationships of low serum vitamin D3 with anthropometry and markers of the metabolic syndrome and diabetes in overweight and obesity. Nutr J. 2008;28(7):4.

    Article  Google Scholar 

  92. 92.

    Li YC, Qiao G, Uskokovic M, et al. Vitamin D: a negative endocrine regulator of the renin-angiotensin system and blood pressure. J Steroid Biochem Mol Biol. 2004;89–90(1–5):387–92.

    PubMed  Article  Google Scholar 

  93. 93.

    National Institutes of Health; National Heart, Lung and Blood Institute; North American Association for the Study of Obesity. The practical guide: identification, evaluation, and treatment of overweight and obesity in adults. October 2000. NIH Publication no. 00-4084.

  94. 94.

    Charakida M, Finer N. Drug treatment of obesity in cardiovascular disease. Am J Cardiovasc Drugs. 2012;12(2):93–104.

    PubMed  Article  CAS  Google Scholar 

  95. 95.

    Scheen AJ. Cardiovascular risk-benefit profile of sibutramine. Am J Cardiovasc Drugs. 2010;10(5):321–34.

    PubMed  Article  CAS  Google Scholar 

  96. 96.

    Topol EJ, Bousser MG, Fox KA, et al. Rimonabant for prevention of cardiovascular events (CRESCENDO): a randomised, multicentre, placebo-controlled trial. Lancet. 2010;376(9740):517–23.

    PubMed  Article  CAS  Google Scholar 

  97. 97.

    Kanders B, Peterson F, Lavin P. Long term health effects associated with significant weight loss: a study of the dose response effect. In: Blackburn GL, Kanders BS, editors. Obesity pathophysiology, psychology and treatment. New York: Chapman & Hall; 1994. p. 167–81.

    Google Scholar 

  98. 98.

    Chaput JP, St-Pierre S, Tremblay A. Currently available drugs for the treatment of obesity: sibutramine and orlistat. Mini Rev Med Chem. 2007;7(1):3–10.

    PubMed  Article  CAS  Google Scholar 

  99. 99.

    Hofbauer KG, Nicholson JR. Pharmacotherapy of obesity. Exp Clin Endocrinol Diabetes. 2006;114(9):475–84.

    PubMed  Article  CAS  Google Scholar 

  100. 100.

    Cooke D, Bloom S. The obesity pipeline: current strategies in the development of anti-obesity drugs. Nat Rev Drug Discov. 2006;5(11):919–31.

    PubMed  Article  CAS  Google Scholar 

  101. 101.

    Halford JC. Obesity drugs in clinical development. Curr Opin Investig Drugs. 2006;7(4):312–8.

    PubMed  CAS  Google Scholar 

  102. 102.

    MacLean LD, Rhode BM, Nohr CW. Late outcome of isolated gastric bypass. Ann Surg. 2000;231(4):524–8.

    PubMed  Article  CAS  Google Scholar 

  103. 103.

    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.

    PubMed  Article  CAS  Google Scholar 

  104. 104.

    Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA. 2008;299(3):316–23.

    PubMed  Article  CAS  Google Scholar 

  105. 105.

    O’Brien PE, Sawyer SM, Laurie C, et al. Laparoscopic adjustable gastric banding in severely obese adolescents: a randomized trial. JAMA. 2010;303(6):519–26.

    PubMed  Article  Google Scholar 

  106. 106.

    Dixon JB, Zimmet P, Alberti KG, et al. Bariatric surgery: an IDF statement for obese type 2 diabetes. Diabet Med. 2011;28(6):628–42.

    PubMed  Article  CAS  Google Scholar 

  107. 107.

    Buchwald H, Estok R, Fahrbach K, et al. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery. 2007;142(4):621–32 (discussion 632–5).

    Google Scholar 

  108. 108.

    Mechanick JI, Kushner RF, Sugerman HJ, et al. Executive summary of the recommendations of the American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Endocr Pract. 2008;14(3):318–36.

    PubMed  Article  Google Scholar 

Download references

Disclosures

No sources of funding were used to conduct this study or prepare this manuscript. The authors have no conflicts of interest that are directly relevant to the content of this review.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Sarita Dhuper.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Dhuper, S., Buddhe, S. & Patel, S. Managing Cardiovascular Risk in Overweight Children and Adolescents. Pediatr Drugs 15, 181–190 (2013). https://doi.org/10.1007/s40272-013-0011-y

Download citation

Keywords

  • Obstructive Sleep Apnea
  • Bariatric Surgery
  • Laparoscopic Adjustable Gastric Banding
  • Ezetimibe
  • Orlistat