The growing epidemics of obesity, hypertension, and diabetes, in addition to worsening environmental factors such as air pollution, water scarcity, and climate change, have fueled the continuously ...increasing prevalence of cardiovascular diseases (CVDs). This has caused a markedly increasing burden of CVDs that includes mortality and morbidity worldwide. Identification of subclinical CVD before overt symptoms can lead to earlier deployment of preventative pharmacological and nonpharmacologic strategies. In this regard, noninvasive imaging techniques play a significant role in identifying early CVD phenotypes. An armamentarium of imaging techniques including vascular ultrasound, echocardiography, magnetic resonance imaging, computed tomography, noninvasive computed tomography angiography, positron emission tomography, and nuclear imaging, with intrinsic strengths and limitations can be utilized to delineate incipient CVD for both clinical and research purposes. In this article, we review the various imaging modalities used for the evaluation, characterization, and quantification of early subclinical cardiovascular diseases.
Regarding stevia, at this time, the U.S. Food and Drug Administration has not made a determination as to the Generally Recognized As Safe status, but has issued no objection letters for a number of ...Generally Recognized As Safe notifications for stevia sweeteners (http://www. fda.gov/Food/FoodlngrethentsPackaging/ GenerallyRecognizedasSafeGRAS/ GRASNotificationProgram/default.htm). Because all 6 of these NNS have current U.S. Food and Drug Administration approval, issues related to safety of these compounds are not addressed. ...the review that follows is notably limited by the lack of an extensive evidence base.
The American Heart Association recently developed definitions and metrics for monitoring the spectrum of cardiovascular health in adolescents and children. Current nationally representative ...prevalence estimates according to sex and race/ethnicity are unavailable.
We examined the components of cardiovascular health in 4673 participants aged 12 to 19 years (representing ≈33.2 million US adolescents) from the 2005-2010 National Health and Nutrition Examination Surveys. Population prevalence of individual cardiovascular health behaviors and factors was estimated according to American Heart Association criteria for poor, intermediate, and ideal levels. Ideal blood pressure was most prevalent (males, 78%; females, 90%), whereas a dramatically low prevalence of ideal Healthy Diet Score was observed (males, <1%; females, <1%). Females exhibited a lower prevalence of ideal total cholesterol (65% versus 72%, respectively) and ideal physical activity levels (44% versus 67%, respectively) yet a higher prevalence of ideal blood glucose (89% versus 74%, respectively) compared with males. Approximately two thirds of adolescents exhibited ideal body mass index (males, 66%; females, 67%) and ideal smoking status (males, 66%; females, 70%). Less than 50% of adolescents exhibited ≥5 ideal cardiovascular health components (45%, males; 50%, females). Prevalence estimates according to sex were consistent across race/ethnic groups.
The low prevalence of ideal cardiovascular health behaviors in US adolescents, particularly physical activity and dietary intake, will likely contribute to a worsening prevalence of obesity, hypertension, hypercholesterolemia, and dysglycemia as the current US adolescent population reaches adulthood. Population-wide emphasis on establishment of ideal cardiovascular health behaviors early in life is essential for maintenance of ideal cardiovascular health throughout the lifespan.
To determine whether prior type 2 diabetes (T2D) treatment or glycemic control over time are independently associated with heart rate variability (HRV) and whether the presence of cardiac autonomic ...dysfunction is associated with arterial stiffness in young adults with youth-onset T2D enrolled in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study.
Heartbeats over 10 min were measured to derive the normal R-Rs (NN intervals). Outcomes included the standard deviation of the NN intervals (SDNN), the root mean square differences of successive NN intervals (RMSSD), percent of NN beats that differ by more than 50 ms (PNN50), and the low-frequency (LF) power domain, high-frequency (HF) power domain, and their ratio (LF:HF). Autonomic dysfunction was defined as ≥3 of 5 abnormal HRV indices compared with obese controls from a separate study.
A total of 397 TODAY participants were evaluated 7 years after randomization. TODAY participants had reduced HRV (SDNN; 57.9 ± 29.6 ms vs. controls 67.1 ± 25.4 ms;
< 0.0001) with parasympathetic loss (RMSSD; 53.0 ± 36.6 ms vs. controls 67.9 ± 35.2 ms;
< 0.0001) with sympathetic overdrive (LF:HF ratio; 1.4 ± 1.7 vs. controls 1.0 ± 1.1;
< 0.0001). Cardiac autonomic dysfunction was present in 8% of TODAY participants, and these participants had greater pulse wave velocity compared with those without dysfunction (
= 0.0001). HRV did not differ by randomized treatment, but higher hemoglobin A1c (HbA
) over time was independently associated with lower SDNN and RMSSD and higher LF:HF ratio after adjustment for age, race-ethnicity, sex, and body mass index.
Young adults with youth-onset T2D show evidence of cardiac autonomic dysfunction with both parasympathetic and sympathetic impairments that are associated with higher HbA
.
Objective To examine the relative effects of high blood pressure (HBP) and obesity on left ventricular mass (LVM) among African-American adolescents; and if metabolic or inflammatory factors ...contribute to LVM. Study design Using a 2 × 2 design, African-American adolescents were stratified by body mass index percentile (body mass index <95th percentile = non-obese; ≥95th percentile = obese) and average blood pressure (BP) (normal BP <120/80 mm Hg; HBP ≥120/80). Glucose, insulin, insulin resistance, lipids, and inflammatory cytokines were measured. From echocardiography measures of LVM, calculated LVM index (LVMI) ≥95th percentile defined left ventricular hypertrophy (LVH). Results Data included 301 adolescents (48% female), mean age 16.2 years, 51% obese, and 29% HBP. LVMI was highest among adolescents with both obesity and HBP. The multiplicative interaction of obesity and HBP on LVH was not significant (OR = 2.35, P = .20) but the independent additive associations of obesity and HBP with log-odds of LVH were significant; obesity OR = 3.26, P < .001; HBP OR = 2.92, P < .001. Metabolic and inflammatory risk factors were associated with obesity, but had no independent association with LVMI. Compared with those with average systolic BP (SBP) <75th percentile, adolescents with SBP from the 75th percentile to 90th percentile had higher LVMI (33.2 vs 38.7 g/m2.7 , P < .001) and greater LVH (18% vs 43%, P < .001), independent of obesity. Conclusions Prevalence of LVH is highest among African-American adolescents with average BP ≥120/80 mm Hg and obesity. There also is an independent association of LVMI with BP, beginning at the 75th SBP percentile.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Since the American Heart Association last presented nutrition guidelines for children, significant changes have occurred in the prevalence of cardiovascular risk factors and nutrition behaviors in ...children. Overweight has increased, whereas saturated fat and cholesterol intake have decreased, at least as percentage of total caloric intake. Better understanding of children's cardiovascular risk status and current diet is available from national survey data. New research on the efficacy of diet intervention in children has been published. Also, increasing attention has been paid to the importance of nutrition early in life, including the fetal milieu. This scientific statement summarizes current available information on cardiovascular nutrition in children and makes recommendations for both primordial and primary prevention of cardiovascular disease beginning at a young age.
Background Familial hypercholesterolemia (FH) is a hereditary condition caused by various genetic mutations that lead to significantly elevated low-density lipoprotein cholesterol levels and ...resulting in a 20-fold increased lifetime risk for premature cardiovascular disease. Although its prevalence in the United States is 1 in 300 to 500 individuals, <10% of FH patients are formally diagnosed, and many are not appropriately treated. Contemporary data are needed to more fully characterize FH disease prevalence, treatment strategies, and patient experiences in the United States. Design The Familial Hypercholesterolemia Foundation (a patient-led nonprofit organization) has established the CAscade SCreening for Awareness and DEtection of Familial Hypercholesterolemia (CASCADE FH) Registry as a national, multicenter initiative to identify US FH patients, track their treatment, and clinical and patient-reported outcomes over time. The CASCADE FH will use multiple enrollment strategies to maximize identification of FH patients. Electronic health record screening of health care systems will provide an efficient mechanism to identify undiagnosed patients. A group of specialized lipid clinics will enter baseline and annual follow-up data on demographics, laboratory values, treatment, and clinical events. Patients meeting prespecified low-density lipoprotein or total cholesterol criteria suspicious for FH will have the opportunity to self-enroll in an online patient portal with information collected directly from patients semiannually. Registry patients will be provided information on cascade screening and will complete an online pedigree to assist with notification of family members. Summary The Familial Hypercholesterolemia Foundation CASCADE FH Registry represents a novel research paradigm to address gaps in knowledge and barriers to comprehensive FH screening, identification, and treatment.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Whether BMI captures adiposity and cardiometabolic risk in Down syndrome (DS), a condition associated with obesity, short stature, and altered body proportions, is not known. We compared ...cardiometabolic risk measures in youth with DS and typically developing matched controls.
Youth with (
= 150) and without (
= 103) DS of comparable age (10-20 years), sex, race, ethnicity, and BMI percentile underwent whole-body dual-energy X-ray absorptiometry, fasting glucose, insulin, lipids, lipoprotein particles, inflammatory factors, and when BMI percentile ≥85, an oral glucose tolerance test.
Sixty-four percent of youth with DS had BMI percentile ≥85. Among these, no difference in glucose, insulin, or insulin resistance was detected, but prediabetes was more prevalent with DS (26.4% vs 10.3%;
= .025) after adjustment for demographics, pubertal status, and BMI
score (odds ratio = 3.2;
= .026). Among all participants, those with DS had higher low-density lipoprotein cholesterol (median 107 interquartile range 89-128 vs 88.5 79-103 mg/dL;
< .00005), triglycerides (89.5 73-133 vs 71.5 56-104 mg/dL;
< .00005), non-high-density lipoprotein cholesterol (non-HDL-C; 128 104-153 vs 107 92-123 mg/dL;
< .00005), and triglycerides/HDL-C (2.2 1.6-3.4 vs 1.7 1.1-2.5 mg/dL;
= .0003) and lower levels of HDL-C (41 36.5-47 vs 45 37-53 mg/dL;
= .012). DS youth had higher high-sensitivity C-reactive protein, interleukin-6, small low-density lipoprotein particles (LDL-P), and total LDL-P, but similar LDL-P size. Youth with DS had less visceral fat (VFAT), fat mass, and lean mass for BMI
score, but greater VFAT at higher fat mass. However, VFAT did not fully explain the increased prevalence of dyslipidemia or prediabetes in youth with DS.
Despite similar insulin resistance, youth with DS had greater prevalence of dyslipidemia and prediabetes than typically developing youth, which was not fully explained by VFAT.
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