[Selected new atherosclerosis risk factors and markers of fibrinolysis in children and adolescents with obesity, hypertension and diabetes]

Abstract

In last years it has been proved that atherosclerosis risk factors are present in children and adolescents, and that already in their young age they are connected with anatomic, atherosclerosis changes in vessels. The aim of the study was to evaluate levels of selected new atherosclerosis risk factors (Lp(a), apo A-I, apo B, homocysteine, fibrinogen) and markers of fibrinolysis (t-PA and PAI-1) in children and adolescents with traditional risk factors (obesity, hypertension, diabetes).

Materials and methods: The study group consisted of 285 children and adolescents aged 14.3 yrs. Children were divided according to their main disease into groups: children with obesity (n = 49), children with obesity and coexisting hypertension (n = 56), children with hypertension (n = 58) and children with diabetes (n = 122). Control group consisted of 79 healthy children and adolescents aged 13.3 yrs. Lp(a), apo A-I and apo B levels were estimated by use of immunoturbidimetric methods, total homocysteine, fibrinogen, t-PA and PAI-1 were estimated by use of immunoenzymatic methods.

Results: Lp(a) level in the total study group was 0.30 g/L and was over twice higher than in the control group -0.14 g/L. Apo A-I level was significantly lower in obese children (1.27 g/L) and in the group with obesity and coexisting hypertension (1.25 g/L) vs 1.35 g/L in controls. Apo B level was significantly higher in the total study group (0.86 g/L) and in groups with obesity, obesity and coexisting hypertension and diabetic children vs 0.73 g/L in controls. Hcy was higher in the group with obesity and coexisting hypertension (8 mumol/L) and in the group with hypertension (9.4 mumol/L) vs 6.2 mumol/L in control group. FB level was higher in the total study group (2.76 g/L) and in groups of obese children (3.18 g/L) and obesity coexisting with hypertension (3.22 g/L) vs 2.52 g/L in controls. Significantly higher t-PA level was found in the obese group (9 micrograms/L) and obesity with hypertension group (9.7 micrograms/L) vs 7.3 mg/L in controls, and PAI-1 level was significantly higher in total study group (62.3 micrograms/L) and groups of obese children (73.8 micrograms/L), obese and hypertensive (78 micrograms/L) and hypertensive (73 micrograms/L) vs 42.4 micrograms/L in control group. 28% of study children had positive family history of cardiovascular diseases.

Conclusion: 1. Young patients with obesity, hypertension or obesity present significant lipid metabolism disturbances, regarding mainly total cholesterol, LDL, triglycerides, and Lp(a) and apo B levels. Unfavourable lipid profile is characteristic mainly in children with obesity and coexisting hypertension. 2. Elevated homocysteine level is found in children with hypertension. 3. Elevated fibrinogen level and diminished fibrinolytic activity characterises obese children. 4. Children and adolescents with obesity, hypertension or diabetes often come from families with positive family history of cardiovascular diseases and other atherosclerosis risk factors.