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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2009;29:943.)
© 2009 American Heart Association, Inc.

Clinical and Population Studies

HDL-Cholesterol, Blood Pressure, and Asymmetric Dimethylarginine Are Significantly Associated With Arterial Wall Thickness in Children

Julian G. Ayer; Jason A. Harmer; Shirley Nakhla; Wei Xuan; Martin K.C. Ng; Olli T. Raitakari; Guy B. Marks; David S. Celermajer

From the Department of Cardiology (J.G.A., J.A.H., M.K.C.N., D.S.C.), Royal Prince Alfred Hospital, Sydney, Australia; the Heart Research Institute (J.G.A., S.N., M.K.C.N., D.S.C.), Sydney, Australia; the Woolcock Institute of Medical Research (W.X., G.B.M.), Sydney, Australia; the Department of Clinical Physiology (O.T.R.), University of Turku, Finland; and the Department of Medicine and Bosch Institute (J.G.A., M.K.C.N., D.S.C.), the University of Sydney, Australia.

Correspondence to Professor David Celermajer, Department of Cardiology, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050 Australia. E-mail david.celermajer{at}email.cs.nsw.gov.au

Objective— Atherosclerosis is found at autopsy in the arteries of adolescents and young adults. Arterial wall thickening may be assessed in vivo by ultrasound measurement of the carotid intima media thickness (CIMT), a marker of subclinical atherosclerosis. As the determinants of arterial wall thickness in childhood are unknown, we assessed the influence of cardiovascular risk factors on CIMT in 8-year-old children.

Methods and Results— A community-based sample of 405 children (age 8.0±0.1 years, 49% girls) had anthropometry, family history, blood pressure (BP), and CIMT measured. A blood sample was collected for HDL and non-HDL cholesterol, apolipoproteins A1 and B, high-sensitivity C-reactive protein, bilirubin, and asymmetric dimethylarginine (ADMA, an endogenous nitric oxide inhibitor). CIMT was significantly associated with systolic BP (r=0.17, P<0.001), diastolic BP (r=0.10, P=0.04), HDL (r=–0.13, P=0.02), and ADMA (r=0.18, P=0.001). CIMT was significantly higher in children with premature parental CHD (0.63±0.07 versus 0.59±0.06 mm, P=0.03). On multivariate analysis, HDL (β coefficient=–0.02, P=0.04), ADMA (β coefficient=0.05, P<0.001), and systolic BP (β coefficient=0.001, P=0.003) were significantly and independently associated with CIMT.

Conclusions— Lower HDL-cholesterol, higher levels of ADMA, and systolic BP are significantly associated with greater arterial wall thickness in early childhood.

The extent to which traditional and novel risk factors for atherosclerosis influence carotid intima media thickness (CIMT) in prepubertal children was evaluated in 405 community-based 8-year-old boys and girls. Systolic blood pressure, HDL-cholesterol, and asymmetrical dimethylarginine were independently associated with CIMT. CIMT was also significantly greater in children with a positive parental history of premature coronary heart disease.

Key Words: HDL-cholesterol • asymmetric dimethylarginine • pediatric • intima-media thickness • blood pressure