Evaluation of early metabolic and vascular risk in children of parents with early ischaemic heart disease

peer-reviewedAtherosclerotic cardiovascular disease is the leading cause of death in Ireland and throughout the developed world. Where a parent has had an early cardiac event, their offspring are at risk of developing heart problems in the future. In this study, we assessed children aged between 8-14 years, whose fathers had premature cardiac (or heart) disease defined as early heart attacks, heart bypass surgery, or angioplasty and evaluated these children [subjects, n=38] for early evidence of atherosclerosis and metabolic abnormalities and compared them to children whose parents do not have known early heart disease [controls, n=25]. The following evaluations were performed: anthropometrics; medical history; family history; fasting lipids; oral glucose tolerance testing; glycosylated haemoglobin (HbA1c); fibrinogen; Carotid Intima Media Thickness measurement; assessment of endothelial function by peripheral applanation tonometry; 24-hour ambulatory blood pressure recordings; blood pressure indices for gender and height [BPI(height)] as well as gender and age [BPI(age)] were calculated. Subjects compared to controls were found to have: higher BMIs (18.7 vs 17.3kg/m2, p=0.01); similar BMI-standard deviation scores; higher waist/height ratios (0.47 vs 0.43, p=0.05); similar waist/hip ratios; similar fasting glucose and insulin sensitivity; similar fasting lipid profiles; lower alanine aminotransferase (ALT) level (16.96 vs 20.67IU/L, p=0.009); similar carotid intima media thickness measurements; lower reactive hyperemia peripheral arterial tonometry (RH-PAT) scores (1.64 vs 2.00, p=0.01), indicating relative endothelial dysfunction; similar mean systolic ambulatory blood pressure; higher mean diastolic ambulatory blood pressure (68.6 vs 65.4mmHg, p=0.02); higher mean diastolic blood pressure index for height (BPI [height]) (0.90 vs 0.86, p=0.03); higher mean diastolic blood pressure index for age (BPI [age]) (0.91 vs 0.87, p=0.02); higher mean arterial blood pressure index [age] (0.93 vs 0.90, p=0.03). Differences in mean ambulatory blood pressure (84.1 vs 81.3mmHg, p=0.06) and mean arterial pressure BPI [height] (0.93 vs 0.90mmHg, p=0.09) did not reach statistical significance. Metabolic tests did not demonstrate differences between children with paternal history of premature cardiovascular disease and controls. We did not find evidence to support targeted lipid screening based on a paternal history of premature cardiovascular disease. This is interesting, as the current guidelines suggest using lipid screening to monitor for risk in our subject population. Our vascular testing results suggest early impaired vascular health relative to controls in healthy children whose fathers have premature cardiovascular disease. This is the first study to evaluate endothelial function and 24 hour ambulatory blood pressure measurements in children with a parental history of premature cardiovascular disease