Obese, Diabetic Youths Have Artery Plaque
Findings Suggest Early Heart
Disease
By Salynn Boyles
WebMD Health News
Reviewed by Elizabeth Klodas, MD, FACC
May 26, 2009 -- Teens and young adults who are obese or
have type 2 diabetes show early warning signs of heart disease, a new study shows.
Researchers from Cincinnati Children's Hospital used ultrasound imaging to
confirm the presence of fatty plaque buildup in the carotid arteries of
young people who were obese or had type 2 diabetes. Carotid arteries are found
in the neck and carry blood from the heart to the brain.
Compared to normal-weight youths, the carotid arteries of obese youths and
diabetic youths were thicker and stiffer, according to study findings.
Carotid artery
thickness and stiffness are risk factors for heart attack and stroke in adults.
Evidence of plaque buildup in this critical artery early
in life strongly suggests that the obesity epidemic in children
will have a dramatic impact on heart and vascular disease rates in the years to come, study authors say.
"Because this damage is progressive and has started so
early, this may be the first generation that has a shorter life expectancy than
their parents," said lead researcher Elaine Urbina, MD, who is director of
preventive cardiology at
Cincinnati Children's Hospital.
Obesity and Heart Disease
The study included 128 children, teens, and young adults
(age range 10 to 24) with type 2 diabetes, which is strongly associated with
obesity; 136 obese young people without diabetes; and 182 age-matched youth
without diabetes who were not overweight.
The average age of the study participants was 18.
Not surprisingly, those with obesity or type 2 diabetes
were more likely than the normal-weight youths to have several traditional heart
disease risk factors, including high blood pressure and high cholesterol. But these differences only
partly explained the significant changes in carotid artery thickness and
stiffness.
The participants with type 2 diabetes had the most plague buildup in their
carotid arteries, but non-diabetic obese participants were not far behind, and
both groups displayed similar significant increases in carotid artery stiffness
compared to lean controls.
Urbina says this suggests that obesity-related artery damage may be occurring
long before obesity-related diseases do.
"It appears that this functional abnormality is already present in obese
youth well before they go on to develop type 2 diabetes," she tells WebMD.
The new research appears in the latest issue of the American Heart
Association journal Circulation.
What Should Kids' Arteries Look Like?
It was not clear how abnormal the carotid arteries of the obese and diabetic
children, teens, and young adults in the study were because there is little to
define normal in these age groups, Urbina says.
"We know what the carotid arteries of someone who is 35 or 40 are supposed to
look like, but we are not really sure what they should look like in younger
people because this has not been studied," she says.
Until those studies are done, she says, screening at-risk children for artery
damage makes little sense.
"If this does become an effective screening tool, it
could help us identify the really high-risk kids who should be on blood pressure
drugs or statins [for high cholesterol] or who would benefit from [ weight loss]
surgery," she says.
In another recent study, researchers reported that the carotid arteries of
obese children and teens whose average age was 13 resembled those of an average
45-year-old.
The lead author of that study tells WebMD that the increasing burden of
obesity among children may translate to significantly more heart and vascular
disease in as little as a decade.
"We know how to take care of adults with risk factors like high blood
pressure and high cholesterol, but we know much less about how to best address
these risk factors in children," says cardiologist and professor of pediatrics
Geetha Raghuveer, MD, of the University of Missouri, Kansas City School of
Medicine.
Columbia University cardiologist Lee Goldman, MD, and colleagues used a
computerized model to predict heart disease incidence in the coming decades. The
model suggests that by 2035, 100,000 additional cases of heart disease will
occur in the U.S. as a result of the current obesity epidemic.
The finding was published late in 2007 in the New England Journal of
Medicine.
Goldman says the newly published research does not prove that heart disease
related to obesity and diabetes is occurring earlier in life, but the research
as a whole is pointing in that direction.
"This is one more piece of evidence in a logical link that type 2 diabetes in
adolescence is looking like type 2 diabetes in adults, and that is bad," he
tells WebMD.
SOURCES:
Urbina, E.M., Circulation, June 2009; online edition.
Elaine M. Urbina, MD, director of preventive cardiology, Cincinnati Children's
Hospital Memorial Center Heart Institute; associated professor of pediatrics,
University of Cincinnati.
Lee Goldman, MD, executive vice president for health and biomedical sciences,
Columbia University, New York, N.Y. Geetha Raghuveer, MD, cardiologist,
Children's Mercy Hospital, Kansas City, Mo.
WebMD Health News: "Forecast: Tsunami of Heart Disease."
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