Noninvasive Assessment of Subclinical Atherosclerosis in Children and Adolescents: Recommendations for Standard Assessment for Clinical Research

Deterioration in endothelial function and arterial stiffness are early events in the development of cardiovascular diseases. In adults, noninvasive measures of atherosclerosis have become established as valid and reliable tools for refining cardiovascular risk to target individuals who need early intervention. With limited pediatric data, the use of these techniques in children and adolescents largely has been reserved for research purposes. Therefore, this scientific statement was written to review the current literature on the noninvasive assessment of atherosclerosis in children and adolescents, make recommendations for the standardization of these tools for research, and stimulate further research with a goal of developing valid and reliable techniques with normative data for noninvasive clinical evaluation of atherosclerosis in pediatric patients. Precise and reliable noninvasive tests for atherosclerosis in youth will improve our ability to estimate future risk for heart attack and stroke. Currently, large longitudinal studies of cardiovascular risk factors in youth, such as the Bogalusa and Muscatine studies, lack sufficient adult subjects experiencing hard outcomes, such as heart attack and stroke, to produce meaningful risk scores like those developed from Framingham data.

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ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults: A Report of the American College of Cardiology Foundation

It is essential that the medical profession play a central role in critically evaluating the evidence related to drugs, devices, and procedures for the detection, management, or prevention of disease. Properly applied, rigorous, expert analysis of the available data documenting absolute and relative benefits and risks of these therapies and procedures can improve the effectiveness of care, optimize patient outcomes, and favorably affect the cost of care by focusing resources on the most effective strategies. One important use of such data...

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Methods for evaluating endothelial function: a position statement from the European Society of Cardiology Working Group on Peripheral Circulation

Authors: John Lekakis, Pierre Abraham, Alberto Balbarini, Andrew Blann, Chantal M Boulanger, John Cockcroft, Francesco Cosentino, John Deanfield, Augusto Gallino, Ignatios Ikonomidis, Dimitrios Kremastinos, Ulf Landmesser, Athanase Protogerou, Christodoulos Stefanadis, Dimitris Tousoulis, Giuseppe Vassalli, Hans Vink, Nikos Werner, Ian Wilkinson and Charalambos Vlachopoulos.

The endothelium holds a pivotal role in cardiovascular health and disease. Assessment of its function was until recently limited to experimental designs due to its location. The advent of novel techniques has facilitated testing on a more detailed basis, with focus on distinct pathways. This review presents available in-vivo and ex-vivo methods for evaluating endothelial function with special focus on more recent ones. The diagnostic modalities covered include assessment of epicardial and microvascular coronary endothelial function, local vasodilation by venous occlusion plethysmography and flow-mediated dilatation, arterial pulse wave analysis and pulse amplitude tonometry, microvascular blood flow by laser Doppler flowmetry, biochemical markers and bioassays, measurement of endothelial-derived microparticles and progenitor cells, and glycocalyx measurements. Insights and practical information on the theoretical basis, methodological aspects, and clinical application in various disease states are discussed. The ability of these methods to detect endothelial dysfunction before overt cardiovascular disease manifests make them attractive clinical tools for prevention and rehabilitation.

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Инфекция у детей и ФМД

Автор: Marietta Charakida, Ann E. Donald

Atherosclerosis as a clinical disease usually presents in middle and late adulthood, but the pathogenesis of this disease starts very early, often from the first decade of life. Classic risk factors, including hypercholesterolemia, obesity, and diabetes, have been associated with accelerated atherosclerosis in children, which has been linked to cardiovascular morbidity and mortality in later life. It is likely, however, that other influences may be important for initiation and progression of early disease.

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Физические упражнения, питание и хронические заболевания

Автор: Christian K. Roberts

Currently, modern chronic diseases, including cardiovascular diseases, Type 2 diabetes, metabolic syndrome, and cancer, are the leading killers in Westernized society and are increasing rampantly in developing nations. In fact, obesity, diabetes, and hypertension are now even commonplace in children. Clearly, however, there is a solution to this epidemic of metabolic disease that is inundating today’s societies worldwide: exercise and diet. Overwhelming evidence from a variety of sources, including epidemiological, prospective cohort, and intervention studies, links most chronic diseases seen in the world today to physical inactivity and inappropriate diet consumption. The purpose of this review is to 1) discuss the effects of exercise and diet in the prevention of chronic disease, 2) highlight the effects of lifestyle modification for both mitigating disease progression and reversing existing disease, and 3) suggest potential mechanisms for beneficial effects.

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Потребление полифенолов и ССЗ: влияние на эндотелиальную и тромбоцитарную функции

Автор: Joseph A. Vita

Epidemiologic studies suggest that higher polyphenol intake from fruits and vegetables is associated with decreased risk for cardiovascular disease. The mechanisms explaining this observation remain unclear. This review summarizes data suggesting that flavonoids improve endothelial function and inhibit platelet aggregation in humans. The vascular endothelium is a critical regulator of vascular homeostasis, and endothelial dysfunction contributes to the pathogenesis and clinical expression of coronary artery disease. Platelet aggregation is a central mechanism in the pathogenesis of acute coronary syndromes, including myocardial infarction and unstable angina. For these reasons, the observed effects of flavonoids on endothelial and platelet function might explain, in part, the observed beneficial effects of flavonoids on cardiovascular disease risk.

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Потребление флавоноидов и развитие ССЗ: влияние на эндотелиальную функцию

Автор: Joseph A. Vita

Epidemiological studies suggest that tea consumption is associated with reduced cardiovascular disease risk, but the mechanisms for these observations have remained uncertain. In recent years, it has become apparent that the endothelium plays a central role in the regulation of vascular homeostasis and that endothelial dysfunction contributes to the pathogenesis and clinical expression of cardiovascular disease. This article reviews the evidence that human tea consumption has a beneficial effect on the vascular endothelium and the clinical implications of these findings.

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О влиянии физических упражнений на эндотелиальную функцию

Автор: Daniel J. Green

Vascular endothelial function is essential for maintenance of health of the vessel wall and for vasomotor control in both conduit and resistance vessels. These functions are due to the production of numerous autacoids, of which nitric oxide (NO) fas been the most widely studied. Exercise training has been shown, in many animal and human studies, to augment endothelial, NO-dependent vasodilatation in both large and small vessels. The extent of the improvement in humans depends upon the muscle mass subjected to training; with forearm exercise, changes are restricted to the forearm vessels while lower body training can induce generalized benefit.

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Пульсовое давление и артериальная жёсткость у крыс - сравнение с человеком

Автор: Michael E Safar

THE DEVELOPMENT of appropriate animal models for investigating human hypertension has been extremely valuable for studies of the natural history and the pathophysiological mechanisms of the disease. It has been considered that there is a strong similarity between spontaneously hypertensive rats (SHR) and patients with essential hypertension. Both have their apparent onsets of the condition very early in life, a reflection of their genetic backgrounds. The arterial hypertension involves a progressive increase of vascular resistance that initiates profound cardiac and systemic vascular adaptations and produces parallel increases of systolic (S), diastolic (D), and mean (M) arterial blood pressure (BP). Neural mechanisms seem to predominate in the early stages of both species’ hypertensive diseases (especially in SHR), although in rats, multiple structural and functional disorders seem to be involved.

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Применение анализа периферической пульсовой волны в клинике

Автор: Christopher S Hayward

Nitric oxide (NO) is recognized to be a potent smooth muscle relaxant responsible, in large part, for vasodilation in response to stimulation of an intact endothelium. The obligatory role of the endothelium in vasodilation offers a mechanism whereby arterial “health” can be assessed prior to the development of atheroma. Studies have confirmed that endothelial dysfunction occurs prior to atheroma formation, and assessment of endothelial function has been used as a surrogate marker for arterial damage. Although these studies have examined endothelial function in the brachial artery (by ultrasound measurement of brachial artery flow-mediated dilation in response to reactive hyperemia), fundamental to the significance of the technique is the close relationship demonstrated between peripheral endothelial dysfunction and coronary atheroma.

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Неинвазивная оценка эндотелиальной функции: выбор методики

Автор: Ann E Donald

The vascular endothelium is a key signal transducer in atherogenesis. Study of preclinical vascular disease has been facilitated by use of non-invasive ultrasound techniques. The vasodilator response to increased conduit arterial flow (flow-mediated dilation [FMD]) is dependent on local nitric oxide (NO) bioavailability, and measurement of this response has been widely used in clinical studies. Recently, alternative non-invasive techniques have been developed with beta2 adrenoceptor agonist-mediated endothelial NO release, using measurement of the response with radial artery applanation tonometry (pulse wave analysis [PWA]) or digital photoplethysmography (pulse contour analysis [PCA]). Although the equipment is small, portable, and easy to use, the comparative reproducibility of PWA and PCA and their ability to detect acute vascular changes have not been determined. We designed this study to assess the reproducibility of PWA, PCA, and FMD in children and adults and compared their ability to detect inflammation-induced changes in vascular function.

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О контурном анализе пульсовой волны объёма

Автор: Sandrine C. Milasseau

Analysis of the contour of the peripheral pulse to assess arterial properties was first described in the nineteenth century. With the recognition of the importance of arterial stiffness there has been a resurgence of interest in pulse wave analysis, particularly the analysis of the radial pressure pulse acquired using a tonometer. An alternative technique utilizes a volume pulse. This may conveniently be acquired optically from a finger (digital volume pulse). Although less widely used, this technique deserves further consideration because of its simplicity and ease of use. As with the pressure pulse, the contour of the digital volume pulse is sensitive to changes in arterial tone induced by vasoactive drugs and is influenced by ageing and large artery stiffness. Measurements taken directly from the digital volume pulse or from its second derivative can be used to assess these properties. This review describes the background to digital volume pulse contour analysis, how the technique relates to contour analysis of the pressure pulse, and current and future applications.

J Hypertens 24:1449–1456 Q 2006 Lippincott Williams & Wilkins.

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