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Aortic, carotid intima-media thickness and flow- mediated dilation as markers of early atherosclerosis in a cohort of pediatric patients with rheumatic diseases

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Abstract

The aims of this study were to identify the presence of endothelial dysfunction as a marker of early atherosclerosis by measuring aortic and carotid intimal-medial thickness (aIMT and cIMT) and flow-mediated dilation (FMD) and their correlation with traditional and no traditional risk factors for atherosclerosis in children with rheumatic diseases. Thirty-nine patients (mean age 15.3 ± 5.7 years), 23 juvenile idiopathic arthritis, 9 juvenile spondyloarthropathies, 7 connective tissue diseases (mean disease duration and onset respectively 5 ± 3.6 and 10 ± 5 years), and 52 healthy children matched for sex and age were enrolled. Demographic data (age, sex, familiarity for cardiovascular disease), traditional risk factors for atherosclerosis (BMI, active and passive smoking, dyslipidemia), activity disease indexes (reactive count protein, erythrocyte sedimentation rate) autoantibodies, and complement tests were collected. aIMT, cIMT, and FMD were assessed following a standardized protocol by high-resolution ultrasonography. Patients resulted significantly more exposed to passive smoking and had a lower BMI and higher homocysteine level than controls. cIMT and aIMT were significantly higher in patients than controls (p < 0.001) and correlated with age at diagnosis (p < 0.001 r 0.516 and 0.706, respectively) but not with mean disease duration. FMD % was significantly reduced in patients compared to controls (p < 0.001). Subclinical atherosclerosis occurs in pediatric rheumatic diseases, mainly in early onset forms, and aIMT is an earlier marker of preclinical atherosclerosis. Premature endothelial dysfunction could be included in the follow-up of children with rheumatic disorders to plan prevention strategies of cardiovascular disease already in pediatrics.

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Authors and Affiliations

  1. Department of Paediatrics and Infant Neuropsychiatry, Sapienza University of Rome, Rome, Italy

    Emanuela Del Giudice, Anna Dilillo, Franca Viola, Salvatore Cucchiara & Marzia Duse

  2. Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy

    Luciana Tromba & Sara Blasi

  3. Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy

    Giuseppe La Torre

  4. Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy

    Fabrizio Conti

Authors
  1. Emanuela Del Giudice
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  2. Anna Dilillo
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  3. Luciana Tromba
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  4. Giuseppe La Torre
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  5. Sara Blasi
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  6. Fabrizio Conti
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  7. Franca Viola
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  8. Salvatore Cucchiara
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  9. Marzia Duse
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Corresponding author

Correspondence to Emanuela Del Giudice.

Ethics declarations

A written informed consent was given and signed by the parents or caregivers (and from the patients ages >16 years) after detailed information on the nature of the procedures. This study was approved by the hospital ethics committee.

Funding

No specific funding was received from any bodies in the public, commercial, or not-for-profit sectors to carry out the work described in this manuscript.

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Key messages

• Chronic inflammation appears to play a role in the development of atherosclerosis in rheumatic diseases.

• Subclinical atherosclerosis occurs in pediatric rheumatic diseases and aIMT might be an earlier marker.

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Del Giudice, E., Dilillo, A., Tromba, L. et al. Aortic, carotid intima-media thickness and flow- mediated dilation as markers of early atherosclerosis in a cohort of pediatric patients with rheumatic diseases. Clin Rheumatol 37, 1675–1682 (2018). https://doi.org/10.1007/s10067-017-3705-7

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  • DOI: https://doi.org/10.1007/s10067-017-3705-7

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