Study of cardiovascular risk factors among children and adolescents of Samos island

Introduction: Cardiovascular disease (CVD) constitutes one of the leading causes of morbidity and mortality in Western countries. Lipid disorders, hypertension, tobacco smoking, reduced physical activity, alcohol abuse and chronic inflammation are considered as risk factors for premature atherosclerosis and CVD. Obesity, which among children and adolescents has become an epidemic, is one of the most important causes that leads to the establishment of many of the aforementioned risk factors. Worrisome is the fact that obesity as well as other risk factors for CVD may persist or track into adulthood.Purpose: To detect children and adolescents, aged 8-18 years, in west Samos island, who are in danger for early acceleration of atherosclerotic process and adult CVD, especially coronary heart disease. Materials and Methods: An observational, cross-sectional study. Study population consisted of 1,003 subjects, aged 8-18 years, 263 children and 740 adolescents, 514 males and 489 females, from west Samos island (Karlovasi area, a semi-urban and rural area). Detailed family history was taken and clinical examination, including anthropometric and blood pressure (BP) measurements, was performed in all participants. Laboratory tests were conducted in 812 out of 1,003 participants (81%). Serum lipids, lipoproteins, apolipoproteins, high sensitivity C-reactive protein levels, and plasma homocysteine levels were measured in overnight fasting blood samples. Non-HDL-C and atherosclerotic markers were calculated. Statistical analysis was conducted using Stata v.13. P<0.005 was considered statistically significant.Results: Increased body mass index (BMI) was found in 40.2 % (overweight: 26.5%, obese: 13.7%) of the total study population. No statistically significant difference between obese/overweight children and adolescents was found. Among adolescents, obesity was more common in boys. Median levels of LDL-C and non-HDL-C were 93 mg/dl and 110 mg/dl respectively. Mean levels of homocysteine were 4.25 (±2.55) μmol/L and median 3.7 μmol/L. Boys had higher levels of homocysteine, not associated with BMI status. Overweight and obese children/adolescents had significantly higher triglycerides, Lp(a) and apo-B, lower HDL-C and more unfavorable atherosclerotic markers compared with normoweight individuals. Females had significantly higher total cholesterol and HDL-C than males. 11.3% of the adolescents were smokers and 33.2% consumed alcoholic beverages (9.9% consumed considerable amounts of alcohol). Average screen time was 7.8 (SD: 4.3) hours per week and was positively correlated with triglycerides. Mild, moderate and intense exercise was reported by 34%, 52% and 13.9% of the participants respectively. Smokers exercised less, had lower HDL-C and consumed alcohol more frequently. Females exercised more often and more intensely, had less screen time and consumed less often and less amount of alcohol compared with males. Adolescents who lived in a rural area consumed alcohol more frequently than those who lived in a semi-urban area. Moreover, adolescents who consumed alcohol had higher BP and triglycerides but lower HDL-C, while alcohol abuse was an important risk factor for higher triglycerides, LDL-C, and non-HDL-C. Intense exercise was correlated with lower systolic BP.Conclusion: An unexpected high percentage of children and adolescents living in non-urban areas of a remote island in Greece, were overweight or obese and had adopted unhealthy lifestyle habits such as tobacco smoking and alcohol consumption. These habits were associated with well-known risk factors for premature atherosclerosis, such as higher BP and dyslipidemiaΕισαγωγή: Τα καρδιαγγειακά νοσήματα αποτελούν μια από τις κυριότερες αιτίες νοσηρότητας και θνησιμότητας στις δυτικές κοινωνίες. Στους κυριότερους παράγοντες κινδύνου για την εγκατάσταση πρώιμης αθηρωματικής και καρδιαγγειακής νόσου περιλαμβάνονται οι: διαταραχές των λιπιδίων, υπέρταση, κάπνισμα, μειωμένη φυσική δραστηριότητα, κατάχρηση αλκοόλ, χρόνια φλεγμονή. Η παχυσαρκία, η οποία κατά την παιδική/εφηβική ηλικία έχει λάβει επιδημικές διαστάσεις, είναι από τις κυριότερες αιτίες εγκατάστασης πολλών από τους παράγοντες κινδύνου. Ιδιαίτερα ανησυχυτικό είναι το γεγονός ότι τόσο η παχυσαρκία όπως και άλλοι παράγοντες κινδύνου μεταφέρονται από την παιδική/εφηβική στην ενήλικη ζωή.Σκοπός: Πρώιμη ανίχνευση των παιδιών και εφήβων, ηλικίας 8-18 ετών, της δυτικής Σάμου που βρίσκονται σε κίνδυνο να έχουν μια γρηγορότερη εξέλιξη της αθηρωματικής διεργασίας και μεγαλύτερη πιθανότητα να εμφανίσουν πρώιμα κάποια από τις επιπλοκές της και κυρίως αρτηριακή στεφανιαία νόσο.Υλικό και Μεθοδολογία: Η μελέτη είναι επιδημιολογική, παρατηρητική και συγχρονική. Το υλικό της απετέλεσαν 1003 παιδιά και έφηβοι (514 αγόρια, 489 κορίτσια), ηλικίας 8-18 ετών, της δυτικής Σάμου (περιοχή Καρλοβάσου), μίας ημιαστικής και αγροτικής περιοχής, που αποτελούσαν σχεδόν το σύνολο του πληθυσμού αυτής της ηλικιακής ομάδας της περιοχής. Οι 740 ήταν έφηβοι (366 αγόρια) και οι 263 (148 αγόρια) παιδιά προ-εφηβικής ηλικίας. Σε όλα τα παιδιά ελήφθη αναλυτικό οικογενειακό ιστορικό και έγινε λεπτομερής κλινική εξέταση με καταγραφή των σωματομετρικών στοιχείων και της αρτηριακής πίεσης. Εργαστηριακός έλεγχος έγινε σε 812 από τους 1003 συμμετέχοντες (ποσοστό 81%). Σε πρωινό αίμα νηστείας, προσδιορίστηκαν τα επίπεδα λιπιδίων, λιποπρωτεϊνών, απολιποπρωτεϊνών, υψηλής ευαισθησιας CRP και ομοκυστεΐνης και υπολογίστηκαν η non-HDL-C και αθηρωματικοί δείκτες. Η στατιστική ανάλυση πραγματοποηίθηκε με το Stata v.13. Ρ