March 29, 2009 (Orlando, Florida)– Children who have elevated triglyceride levels are at significant risk of cardiovascular disease in their fourth and fifth decades, according to a longitudinal childhood-to-adulthood study presented here at the American College of Cardiology 2009 Scientific Sessions.
Pediatricians and other clinicians who care for children should therefore be vigilant about their blood lipids in general and triglycerides in particular, said Dr Samrat Yeramaneni (Jewish Hospital Cholesterol Center, Cincinnati, OH).
Between 1973 and 1976, researchers assessed body-mass index and lipid profiles, including fasting blood triglyceride levels, of 1756 children in grades 1 through 12 in the Princeton school district of Cincinnati. The mean age of the children at study entry was 12 years (range 9 to 16).
Between 1998 and 2003, investigators located 808 participants from the original cohort and evaluated them for cardiovascular disease events. The mean age at this follow-up was 39 years (range 35 to 43).
Eight MIs Before 40
Nineteen subjects reported a total of 29 cardiovascular events as adults. These included seven angioplasties, one CABG, eight MIs, 11 carotid or femoral bypasses, and two ischemic strokes. The mean age at the first cardiac event was 37 years and ranged from 32 to 42 years.
Compared with the 789 subjects who were free of cardiovascular disease, the 19 subjects who developed CVD had a higher average childhood triglyceride level (127 vs 76 mg/dL; p<0.0001) and body-mass index (24.3 vs 20.0 kg/m2; p=0.012). Seven of these subjects had childhood triglyceride levels that exceeded the pediatric 95th percentile of 153 mg/dL, and of these, six had triglycerides greater than 150 mg/dL as adults, Yeramaneni reported.
Subjects with CVD were also significantly more likely to smoke cigarettes (nine, or 47%, vs 189, or 24%) and to have type 2 diabetes (six, or 32%, vs 31, or 4%) compared with CVD-free subjects.
Peds and Family Docs, Take Heed
"With these findings, we conclude that childhood triglycerides are uniformly, consistently, and independently a significant predictor of early adulthood cardiovascular disease," Yeramaneni told reporters at a press conference here. "We encourage pediatricians and family practitioners to take notice of elevated levels of triglycerides, which are a part of standard lipid profiles, and screen for overweight and obesity as indicators of future risk of CVD and initiate early interventions."
In an interview with heartwire , Yeramaneni said that it would be inappropriate to start children with elevated triglycerides on drugs without first trying diet, weight loss if necessary, and exercise. "We know that obesity and a sedentary lifestyle contribute to elevated triglycerides, so definitely, these should be tried. We recommend following these kids at three-month intervals for a year. Then, and only then, if lifestyle modifications have not worked, we can try drugs, such as omega-3 fatty acids."
Kidney disorders, the birth-control pill, hypothyroidism, and other conditions that can contribute to hypertriglyceridemia should also be ruled out, he said.
"We really have to impress upon parents that their children may be on course for early cardiovascular disease if their triglycerides remain elevated and do all that we can to help these kids."
Both the baseline and follow-up studies were funded by the National Heart Lung and Blood Institute of the National Institutes of Health
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Cite this: ACC 2009: Elevated Triglycerides in Childhood a Harbinger of Cardiovascular Events in Adulthood - Medscape - Mar 29, 2009.