<p>RISK FACTORS FOR SUBCLINICAL ATHEROSCLEROSIS IN </p><p>ASYMPTOMATIC BRAZILIAN CHILDREN.</p><p>REFERENCES</p><p>1. Beauloye V, Zech F, Mong HTT, Clapuyt P, Maes M, Brichard SM (2007) Determinants</p><p> of early atherosclerosis in obese children and adolescents. J Clin Endocrin Metab 92: </p><p>3025-3032</p><p>2. Berenson GS, Srinivasan SR, Bao W, Newman WP 3rd, Tracy RE, Wattigney WA </p><p>(1998) Association between multiple cardiovascular risk factors and atherosclerosis in </p><p> children and young adults. The Bogalusa Heart Study. N Engl J Med 338: 1650-1656</p><p>3. Berenson GS (2002) Childhood risk factors predict adult risk associated with subclinical </p><p> cardiovascular disease. The Bogalusa Heart Study. Am J Cardiol 90 (suppl.): 3L-7L</p><p>4. Cole TJ, Bellizi MC, Flegal KM, Dietz WH (2000) Establishing a standard definition for </p><p> child overweight and obesity worldwide: international survey. BMJ 320: 1240-1243</p><p>5. Conde WL, Monteiro CA (2006) Body mass index cutoff points for evaluation of </p><p> nutritional status in Brazilian children and adolescents. J Pediatr (Rio J) 82: 266-272</p><p>6. Cuomo S, Guarini P, Gaeta G, De Michele M, Boeri F, Dorn J, Bond M, Trevisan M </p><p>(2002) Increased carotid intima-media thickness in children-adolescents, and young </p><p> adults with a parental history of premature myocardial infarction. Eur Heart J 23: 1345-</p><p>1350 2</p><p>7. Executive Summary of the Third Report of the National Cholesterol Education Program </p><p>(NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood </p><p>Cholesterol in Adults (Adult Treatment Panel III) (2001) JAMA 285: 2486-2508</p><p>8. Fox CS, Polak JF, Chazaro I, Cupples A, Wolf PA, D'Agostino RA, O'Donnell CJ (2003)</p><p>Genetic and environmental contributions to atherosclerosis phenotypes in men and </p><p> women: heritability of carotid intima-media thickness in the Framingham Heart Study. </p><p>Stroke 34: 397-401</p><p>9. Freedman DS, Dietz WH, Tang R, Mensah GA, Bond MG, Urbina EM, Srinivasan S, </p><p>Berenson GS (2004) The relation of obesity throughout life to carotid intima-media </p><p> thickness in adulthood: The Bogalusa Heart Study. Int J Obes Metab Disord 28: 159-166</p><p>10. Freedman DS, Patel DA, Srinivasan SR, Chen W, Tang R, Bond MG, Berenson GS </p><p>(2008) The contribution of childhood obesity to adult carotid intima-media thickness: the </p><p>Bogalusa Heart Study. Int J Obes 32: 749-756</p><p>11. Ishizu T, Ishimitsu T, Yanagi H, Obara K, Moriyama N, Watanabe S, Yamaguchi I. </p><p>(2004) Effect of age on carotid arterial intima-media thickness in childhood. Heart </p><p>Vessels 19: 189-195</p><p>12. Juonala M, Raitakari M, Viikari JSA, Raitakari OT (2006) Obesity in youth is not an </p><p> independent predictor of carotid IMT in adulthood. The Cardiovascular Risk in Young </p><p>Finns Study. Atherosclerosis 185: 388-393</p><p>13. Juonala M, Viikari JSA, Räsänen L, Helenius H, Pietikäinen M, Raitakari OT (2006) </p><p>Young adults with family history of coronary heart disease have increased arterial </p><p> vulnerability to metabolic risk factors. The Cardiovascular Risk in Young Finns Study. </p><p>Arterioscler Thromb Vasc Biol 26: 1376-1382 3</p><p>14. Kavey RE, Alada V, Daniels SR, Hayman LL, McCrindle BW, Newburger JW, Parekh </p><p>RS, Steinberger J (2006) Cardiovascular risk reduction in high-risk pediatric patients: a </p><p> scientific statement from the American Heart Association Expert Panel on Population and</p><p>Prevention Science; the Councils on Cardiovascular Disease in the Young, Epidemiology </p><p> and Prevention, Nutrition, Physical Activity and Metabolism, High Blood Pressure </p><p>Research, Cardiovascular Nursing, and the Kidney in Heart Disease; and the </p><p>Interdisciplinary Working Group on Quality of Care and Outcomes Research. Circulation </p><p>114: 2710-2738</p><p>15. Li S, Chen W, Srinivasan SR, Tang R, Urbina EM, Berenson GS (2003) Childhood </p><p> cardiovascular risk factors and carotid vascular changes in adulthood. The Bogalusa Heart</p><p>Study. JAMA 290: 2271-2276</p><p>16. Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M (2007) Prediction of clinical </p><p> cardiovascular events with carotid intima-media thickness. A systematic review and </p><p> meta-analysis. Circulation 115: 459-467</p><p>17. Lusis AJ (. 2000) Atherosclerosis. Nature 407: 233-241</p><p>18. Must A, Jacques PJ, Dallal GE, Bajema CJ, Dietz WH (1992) Long-term morbidity and </p><p> mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922 to</p><p>1935. N Engl J Med 327: 1350-1355</p><p>19. O'Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK Jr (1999) </p><p>Carotid-artery intima and media thickness as a risk factor for myocardial infarction and </p><p> stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N </p><p>Engl J Med 340: 14-22 4</p><p>20. Relationship of atherosclerosis in young men to serum lipoprotein cholesterol </p><p> concentrations and smoking. A preliminary report from the Pathobiological Determinants </p><p> of Atherosclerosis in Youth (PDAY) Research Group (1990) JAMA 264: 3018-3024</p><p>21. Stary HC (1989) Evolution and progression of atherosclerotic lesions in coronary arteries </p><p> of children and young adults. Arteriosclerosis 9 (Suppl 1): I19-I32</p><p>22. Tonstad S, Joakimsen O, Stensland-Bugge E, Leren TP, Ose L, Russell D, Bønaa KH </p><p>(1996) Risk factors related to carotid intima-media thickness and plaque in children with </p><p> familial hypercholesterolemia and control subjects. Arterioscler Thromb Vasc Biol 16: </p><p>984-991</p><p>23. Update on the 1987 Task Force Report on High Blood Pressure in Children and </p><p>Adolescents: a working group report from the National High Blood Pressure Education </p><p>Program. National High Blood Pressure Education Program Working Group on </p><p>Hypertension Control in Children and Adolescents (1996) Pediatrics 98: 649-658</p><p>24. Vicenzini E, Ricciardi MC, Puccinelli F, Guidetti G, Delfini R, Lenzi GL (2007) </p><p>Common carotid artery intima-media thickness determinants in a population study. J </p><p>Ultrsound Med 26: 427-432</p><p>25. World Health Organization. BMI-for-age (5-19 years). </p><p> http://www.who.int/growthref/who2007_bmi_for_age/en/print.html. Assessed May 2, </p><p>2008</p><p>26. Wunsch R, de Souza G, Toschke AM, Reinehr T (2006) Intima-media thickness in obese </p><p> children before and after weight loss. Pediatrics 118: 2334-2340 5</p><p>TABLES</p><p>Table 1: Anthropometric, clinical and laboratory characteristics of the study population. Normal weight Overweight and Variable Total (n=93) (n=52) obese (n=41) Age (months): mean (±SD) 106 (±29) 104 (±28) 109 (±30) Caucasian: n (%) 78 (84) 43 (83) 35 (85) Male: n (%) 49 (53) 27 (52) 22 (54) BMI (kg/m2): mean (±SD) 18.9 (±5.1) 15.6 (±1.7)* 22.7 (±5.1)* Family history of CHD: n (%) 55 (60) 29 (56) 26 (63) DBP (mm Hg): mean (±SD) 68 (±10) 66 (±10) 70 (±10) SBP (mm Hg): mean (±SD) 109 (±14) 107 (±15) 109 (±12) Composite cIMT (mm): mean (±SD) 0.44 (±0.07) 0.43 (±0.06)** 0.46 (±0.08)** Fibrinogen (mol/l): mean (±SD) 8.40 (±2.06) 7.97 (±2.03) 8.76 (±2.03) Glucose (mmol/l): mean (±SD) 4.61 (±0.40) 4.60 (±0.37) 4.62 (±0.45) HDL (mmol/l): mean (±SD) 1.37 (±0.40) 1.42 (±0.34) 1.29 (±0.26) LDL (mmol/l): mean (±SD) 2.32 (±0.74) 2.28 (±0.83) 2.56 (±0.67) T-CHOL (mmol/l): mean (±SD) 4.11 (±1.16) 4.09 (±1.14) 4.22 (±0.78) Triglycerides (mmol/l): median (IQR) 0.76 (0.55–1.03) 0.67 (0.47-0.87)# 0.89 (0.80-1.02)# SD: standard deviation; BMI: body mass index; CHD: cardiovascular heart disease; DBP: diastolic blood pressure; SBP: systolic blood pressure; HDL: high-density lipoprotein cholesterol;</p><p>LDL: low-density lipoprotein cholesterol; T-CHOL: total cholesterol; IQR: interquartile range; cIMT: carotid intima-media thickness; * and **: Student’s t test - P<0.001 and P=0.023, respectively; #: Mann-Whitney test; P=0.010. 6</p><p>Table 2: Pearson’s correlation coefficients for normally distributed variables (P value); n=93. Age Glucose Fibrinogen DBP SBP BMI z-score Composite cIMT Age 1.0 0.200 - 0.102 - 0.020 - 0.014 0.001 0.132 (0.054) (0.331) (0.850) (0.895) (0.995) (0.206)</p><p>Glucose 0.200 1.0 0.051 0.001 0.126 0.151 0.113 (0.054) (0.150) (0.999) (0.227) (0.150) (0.279)</p><p>Fibrinogen - 0.102 0.051 1.0 0.008 0.092 0.254 0.082 (0.331) (0.150) (0.938) (0.383) (0.014) (0.433)</p><p>DBP - 0.020 0.001 0.008 1.0 0.772 0.301 0.107 (0.850) (0.999) (0.938) (<0.001) (0.003) (0.307)</p><p>SBP - 0.014 0.126 0.092 0.772 1.0 0.296 0.256 (0.895) (0.227) (0.383) (<0.001) (0.004) (0.013)</p><p>BMI z-score 0.001 0.151 0.254 0.301 0.296 1.0 0.259 (0.995) (0.150) (0.014) (0.003) (0.004) (0.012) 0.259 Composite cIMT 0.132 0.113 0.082 0.107 0.256 1.0 (0.206) (0.279) (0.433 (0.307 (0.013) (0.012) DBP: diastolic blood pressure; SBP: systolic blood pressure. 7</p><p>Table 3: Spearman’s correlation coefficients for categorical of skewed variables (P value); n=93. Gender CHD CRP T-CHOL HDL TGL Overweight Composite Obesity cIMT 0.045 - 0.062 -0.129 -0.129 - 0.059 Gender 1.0 0.047 0.193 (0.670) (0.554) (0.226) (0.219) (0.572) (0.655) (0.063) 0.045 0.231 - 0.135 - 0.068 - 0.141 0.082 - 0.043 CHD 1.0 (0.670) (0.026) (0.206) (0.521) (0.178) (0.435) (0.681) - 0.062 0.231 0.098 - 0.094 - 0.068 0.027 0.113 CRP 1.0 (0.554) (0.023) (0.360) (0.371) (0.519) (0.800) (0.280) -0.129 - 0.135 0.098 0.251 0.468 0.087 0.060 T-CHOL* 1.0 (0.226) (0.206)) (0.360) (0.018) (<0.001) (0.414) (0.573) -0.129 - 0.068 - 0.094 0.251 - 0.010 - 0.249 - 0.029 HDL* 1.0 (0.219) (0.521)) (0.371) (0.018) (0.927) (0.017) (0.784) - 0.059 - 0.141 - 0.068 0.468 - 0.010 0.297 0.043 TGL 1.0 (0.572) (0.178) (0.519) (<0.001) (0.927) (0.004) (0.682) Overweight/ 0.047 0.082 0.027 0.087 - 0.249 0.297 0.230 1.0 obesity (0.655) (0.435)) (0.800) (0.414) (0.017) (0.004) (0.027) Composite 0.193 - 0.043 0.113 0.060 - 0.029 0.043 0.230 1.0 cIMT (0.063) (0.681)) (0.280) (0.573) (0.784) (0.682) (0.027)</p><p>CHD: coronary heart disease; CRP: C-reactive protein; T-CHOL: total cholesterol;</p><p>HDL: high-density lipoprotein cholesterol; TGL: triglycerides.</p>
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