Skip to main content
SpringerLink
Log in

Synergistic Effects of Elevated Systolic Blood Pressure and Hypercholesterolemia on Carotid Intima–Media Thickness in Children and Adolescents

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

This study aimed to investigate the synergistic effects of elevated systolic blood pressure (SBP) and hypercholesterolemia on carotid intima–media thickness (cIMT). For this study, 60 children with hypercholesterolemia and 40 healthy control children were divided into four subgroups: hypercholesterolemic children with normal (<90th percentile) or elevated (≥90th percentile) SBP and control children with normal or elevated SBP. The highest mean and maximal cIMT values were found in the hypercholesterolemic children with elevated SBP and were significantly different from those of all the other groups. The synergistic effects of elevated SBP and hypercholesterolemia lead to a significant increase in cIMT as a subclinical sign of early atherosclerosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bachorik PS, Ross JW (1995) National cholesterol education program recommendations for measurement of low-density lipoprotein cholesterol: executive summary. Clin Chem 41:1414–1420

    CAS  PubMed  Google Scholar 

  2. Berenson GS, Srinivasan SR, Bao W, Newman WP III, Tracy RE, Wattigney WA (1998) Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. N Engl J Med 338:1650–1656

    Article  CAS  PubMed  Google Scholar 

  3. Bonetti PO, Lerman OL, Lerman A (2003) Endothelial dysfunction: a marker of atherosclerotic risk. Arterioscler Thromb Vasc Biol 23:168–175

    Article  CAS  PubMed  Google Scholar 

  4. Cheng D, Schmidt-Trucksäss A, Cheng K, Burkhardt H (2002) Using snakes to detect the intimal and adventitial layers of the common carotid artery wall in sonography images. Comput Methods Programs Biomed 67:27–37

    Article  PubMed  Google Scholar 

  5. Dalla Pozza R, Bechtold S, Bonfig W, Putzker S, Kozlik-Feldmann R, Netz H, Schwarz HP (2007) Age of onset of type 1 diabetes in children and carotid intima medial thickness. J Clin Endocrinol Metab 92:2053–2057

    Article  CAS  PubMed  Google Scholar 

  6. Daniels SR, Greer FR, The Committee on Nutrition (2008) Lipid screening and cardiovascular health in childhood. Pediatrics 122:198–208

    Google Scholar 

  7. Félétou M, Vanhoutte PM (2006) Endothelial dysfunction: a multifaceted disorder. Am J Physiol Heart Circ Physiol 291:H985–H1002

    Article  PubMed  Google Scholar 

  8. Groner JA, Joshi M, Bauer JA (2006) Pediatric precursors of adult cardiovascular disease: noninvasive assessment of early vascular changes in children and adolescents. Pediatrics 118:1683–1691

    Article  PubMed  Google Scholar 

  9. Halcox JPJ, Deanfield JE (2005) Childhood origins of endothelial dysfunction. Heart 91:1272–1274

    Article  CAS  PubMed  Google Scholar 

  10. Hansen ML, Gunn PW, Kaelber DC (2007) Underdiagnosis of hypertension in children and adolescents. JAMA 298:874–879

    Article  CAS  PubMed  Google Scholar 

  11. Jago R, Harrell JS, McMurray RG, Edelstein S, El Ghormli L, Bassin S (2006) Prevalence of abnormal lipid and blood pressure values among an ethnically diverse population of eighth-grade adolescents and screening implications. Pediatrics 117:2065–2073

    Article  PubMed  Google Scholar 

  12. Järvisalo MJ, Jartti L, Näntö-Salonen K, Irjala K, Rönnemaa T, Hartiala JJ, Celermajer DS, Raitakari OT (2001) Increased aortic intima–media thickness: a marker of preclinical atherosclerosis in high-risk children. Circulation 104:2943–2947

    Article  PubMed  Google Scholar 

  13. Järvisalo MJ, Lehtimäki T, Raitakari OT (2004) Determinants of arterial nitrate-mediated dilatation in children. Circulation 109:2885–2889

    Article  PubMed  Google Scholar 

  14. Kromeyer-Hauschild K, Wabitsch M, Kunze D, Geller F, Geiss HC, Hesse V, von Hippel A, Jaeger U, Johnsen D, Korte W, Menner K, Müller G, Müller JM, Niemann-Pilatus A, Remer T, Schaefer F, Wittchen HU, Zabransky S, Zellner K, Ziegler A, Hebebrand J (2001) Perzentile für den Body-Mass-Index für das Kindes- und Jugendalter unter Heranziehung verschiedener deutscher Stichproben. Monatsschr Kinderheilkd 149:807–818

    Article  Google Scholar 

  15. Lakka TA, Salonen R, Kaplan GA, Salonen JT (1999) Blood pressure and the progression of carotid atherosclerosis in middle-aged men. Hypertension 34:51–54

    CAS  PubMed  Google Scholar 

  16. Lande MB, Carson NL, Roy J, Meagher CC (2006) Effects of childhood primary hypertension on carotid intima–media thickness. Hypertension 48:40–44

    Article  CAS  PubMed  Google Scholar 

  17. Li S, Chen W, Srinivasan SR, Bond MG, Tang R, Urbina EM, Berenson GS (2003) Childhood cardiovascular risk factors and carotid vascular changes in adulthood. JAMA 290:2271–2276

    Article  CAS  PubMed  Google Scholar 

  18. Litwin M, Trelewicz J, Wawer Z, Antoniewicz J, Wierzbicka A, Rajszys P, Grenda R (2004) Intima–media thickness and arterial elasticity in hypertensive children: controlled study. Pediatr Nephrol 19:767–774

    Article  PubMed  Google Scholar 

  19. McGill HC, McMahan CA, Herderick EE, Malcolm GT, Tracy RE, Strong JP (2000) Origin of atherosclerosis in childhood and adolescence. Am J Clin Nutr 72(Suppl):1307S–1315S

    Google Scholar 

  20. McMahan CA, Gidding SS, Malcolm GT, Tracy RE, Strong JP, McGill HC (2006) Pathobiological determinants of atherosclerosis in youth risk scores are associated with early and advanced atherosclerosis. Pediatrics 118:1447–1455

    Article  PubMed  Google Scholar 

  21. McNiece KL, Poffenbarger TS, Turner JL, Franco KD, Sorof JN, Portman RJ (2007) Prevalence of hypertension and prehypertension among adolescents. J Pediatr 150:640–644

    Article  PubMed  Google Scholar 

  22. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114(Suppl):555–576

    Google Scholar 

  23. O’Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK Jr (1999) Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. N Engl J Med 340:14–22

    Article  PubMed  Google Scholar 

  24. Pall D, Settakis G, Katona E, Csiba L, Kakuk G, Limburg M, Bereczki D, Fülesdi B (2003) Increased common carotid artery intima–media thickness in adolescent hypertension. Cerebrovasc Dis 15:167–172

    Article  PubMed  Google Scholar 

  25. Paradis G, Lambert M, O’Loughlin J, Lavallee C, Aubin J, Delvin E, Levy E, Hanley JA (2004) Blood pressure and adiposity in children and adolescents. Circulation 110:1832–1838

    Article  PubMed  Google Scholar 

  26. Raitakari OT, Juonala M, Kähönen M, Taittonen L, Laitinen T, Mäki-Torkko N, Järvisalo MJ, Uhari M, Jokinen E, Rönnemaa T, Akerblom HK, Viikari JSA (2003) Cardiovascular risk factors in childhood and carotid artery intima–media thickness in adulthood. JAMA 290:2277–2283

    Article  CAS  PubMed  Google Scholar 

  27. Reinehr T, Kiess W, de Sousa G, Stoffel-Wagner B, Wunsch R (2006) Intima–media thickness in childhood obesity: relations to inflammatory marker, glucose metabolism, and blood pressure. Metabolism 55:113–118

    Article  CAS  PubMed  Google Scholar 

  28. Rodriguez-Porcel M, Lerman LO, Herrmann J, Sawamura T, Napoli C, Lerman A (2003) Hypercholesterolemia and hypertension have synergistic deleterious effects on coronary endothelial function. Arterioscler Thromb Vasc Biol 23:885–891

    Article  CAS  PubMed  Google Scholar 

  29. Rodriguez-Porcel M, Lerman A, Herrmann J, Schwartz RS, Sawamura T, Condorelli M, Napoli C, Lerman LO (2003) Hypertension exacerbates the effect of hypercholesterolemia on the myocardial microvasculature. Cardiovasc Res 58:213–221

    Article  CAS  PubMed  Google Scholar 

  30. Sass C, Herbeth B, Chapet O, Siest G, Visvikis S, Zannad F (1998) Intima–media thickness and diameter of carotid and femoral arteries in children, adolescents, and adults from the Stanislas cohort: effect of age, sex, anthropometry, and blood pressure. J Hypertens 16:1593–1602

    Article  CAS  PubMed  Google Scholar 

  31. Schmidt-Trucksäss A, Cheng D, Sandrock M, Schulte-Mönting J, Rauramaa R, Huonker M, Burkhardt H (2001) Computerized analysing system using the active contour in ultrasound measurement of carotid artery intima–media thickness. Clin Physiol 21:561–569

    Article  PubMed  Google Scholar 

  32. Schwab KO, Doerfer J, Krebs A, Krebs K, Schorb E, Hallermann K, Superti-Furga A, Zieger B, März W, Schmidt-Trucksäss A, Winkler K (2007) Early atherosclerosis in childhood type 1 diabetes: role of raised systolic blood pressure in the absence of dyslipidaemia. Eur J Pediatr 166:541–548

    Article  PubMed  Google Scholar 

  33. Schwab KO, Doerfer J, Hecker W, Grulich-Henn J, Wiemann D, Kordonouri O, Beyer P, Holl RW (2006) Spectrum and prevalence of atherogenic risk factors in 27, 358 children, adolescents, and young adults with type 1 diabetes: cross-sectional data from the German diabetes documentation and quality management system (DPV). Diabetes Care 29:218–225

    Article  PubMed  Google Scholar 

  34. Sorof JM, Alexandrov AV, Garami Z, Turner JL, Grafe RE, Lai D, Portman RJ (2003) Carotid ultrasonography for detection of vascular abnormalities in hypertensive children. Pediatr Nephrol 18:1020–1024

    Article  PubMed  Google Scholar 

  35. Sorof JM, Cardwell G, Franco K, Portman RJ (2002) Ambulatory blood pressure and left ventricular mass index in hypertensive children. Hypertension 39:903–908

    Article  CAS  PubMed  Google Scholar 

  36. Sun N, Wood NB, Hughes AD, Thom SAM, Xu XY (2007) Effects of transmural pressure and wall shear stress on LDL accumulation in the arterial wall: a numerical study using a multilayered model. Am J Physiol Heart Circ Physiol 292:H3148–H3157

    Article  CAS  PubMed  Google Scholar 

  37. Toikka JO, Laine H, Ahotupa M, Haapanen A, Viikari JSA, Hartiala JJ, Raitakari OT (2000) Increased arterial intima–media thickness and in vivo LDL oxidation in young men with borderline hypertension. Hypertension 36:929–933

    CAS  PubMed  Google Scholar 

  38. Virkola K, Pesonen E, Akerblom HK, Siimes MA (1997) Cholesterol and carotid wall in children and adolescents with familial hypercholesterolaemia: a controlled study by ultrasound. Acta Paediatr 86:1203–1207

    Article  CAS  PubMed  Google Scholar 

  39. Wiegman A, de Groot E, Hutten BA, Rodenburg J, Gort J, Bakker HD, Sijbrands EJG, Kastelein JJP (2004) Arterial intima–media thickness in children heterozygous for familial hypercholesterolaemia. Lancet 363:369–370

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics and Adolescents Medicine, University Hospital, Mathilden Street 1, 79106, Freiburg, Germany

    Andreas Krebs, Janine Alt, Jürgen Doerfer & Karl Otfried Schwab

  2. Department of Preventative and Rehabilitative Sports Medicine, Technical University, 80809, Munich, Germany

    Arno Schmidt-Trucksäss

  3. Department of Clinical Chemistry Center for Internal Medicine, University Hospital, 79095, Freiburg, Germany

    Kristin Krebs & Karl Winkler

Authors
  1. Andreas Krebs
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Arno Schmidt-Trucksäss
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Janine Alt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jürgen Doerfer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kristin Krebs
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Karl Winkler
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Karl Otfried Schwab
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Karl Otfried Schwab.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Krebs, A., Schmidt-Trucksäss, A., Alt, J. et al. Synergistic Effects of Elevated Systolic Blood Pressure and Hypercholesterolemia on Carotid Intima–Media Thickness in Children and Adolescents. Pediatr Cardiol 30, 1131–1136 (2009). https://doi.org/10.1007/s00246-009-9510-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-009-9510-6

Keywords

Search

Navigation