Relationship between endothelial dysfunction, carotid artery intima media thickness and circulating markers of vascular inflammation in obese hypertensive children and adolescents.

Background: Adhesion molecules released by dysfunctional endothelium are considered as markers of vascular inflammation in early atherosclerosis. Non-invasive ultrasound methods are now available to detect first preclinical signs of the disease.

Aim: To investigate the relationship between selected adhesion molecules and ultrasound indicators of early atherosclerosis: endothelial function measured by flow-mediated dilatation (FMD) and intima media thickness (IMT).

Patients: The study group consisted of 85 children, mean age 14.6 years, of whom 22 were obese, 31 were hypertensive, and 32 obese and hypertensive. The control group included 26 healthy children.

Methods: Adhesin concentrations were determined by ELISA. FMD and IMT were evaluated by ultrasound.

Results: A positive correlation was found between sICAM-1 (soluble intercellular adhesion molecule 1) and IMT (r = 0.32, p = 0.013, 95% CI: 0.11 to 0.49) and a negative correlation between IMT and FMD (r = -0.26, p = 0.04, 95% CI: -0.43 to -0.04) in the whole study group. In the particular groups, we found significant correlations only in obese hypertensive children. sICAM-1 correlated positively with IMT (r = 0.52, p = 0.001, 95% CI: 0.2 to 0.72) and negatively with FMD (r = -0.31, p = 0.027, 95% CI: -0.6 to -0.2). sE-selectin correlated positively with IMT (r = 0.41, p = 0.012). In regression models, IMT correlated with sICAM-1 (beta = 0.37, p = 0.03) and body mass index (beta = 0.55, p = 0.02), and FMD correlated negatively with sICAM-1 (beta = -0.47, p = 0.04).

Conclusions: The association between inflammatory markers of the endothelium with impaired vasodilatation activity and the first atherosclerotic structural changes in the common carotid arteries were found in obese hypertensive children and adolescents. The coexistence of obesity and hypertension predisposes these young patients to closely related disturbances connected with early atherosclerosis.