WebMD Medical News
Elizabeth Klodas, MD, FACC
May 26, 2009 -- Teens and young adults who are obese or have type 2 diabetes show early warning signs of heart disease, a new study shows.
Researchers from Cincinnati Children’s Hospital used ultrasound imaging to confirm the presence of fatty plaque buildup in the carotid arteries of young people who were obese or had type 2 diabetes. Carotid arteries are found in the neck and carry blood from the heart to the brain.
Compared to normal-weight youths, the carotid arteries of obese youths and diabetic youths were thicker and stiffer, according to study findings.
Carotid artery thickness and stiffness are risk factors for heart attack and stroke in adults.
Evidence of plaque buildup in this critical artery early in life strongly suggests that the obesity epidemic in children will have a dramatic impact on heart and vascular disease rates in the years to come, study authors say.
“Because this damage is progressive and has started so early, this may be the first generation that has a shorter life expectancy than their parents,” said lead researcher Elaine Urbina, MD, who is director of preventive cardiology at Cincinnati Children’s Hospital.
The study included 128 children, teens, and young adults (age range 10 to 24) with type 2 diabetes, which is strongly associated with obesity; 136 obese young people without diabetes; and 182 age-matched youth without diabetes who were not overweight.
The average age of the study participants was 18.
Not surprisingly, those with obesity or type 2 diabetes were more likely than the normal-weight youths to have several traditional heart disease risk factors, including high blood pressure and high cholesterol. But these differences only partly explained the significant changes in carotid artery thickness and stiffness.
The participants with type 2 diabetes had the most plague buildup in their carotid arteries, but non-diabetic obese participants were not far behind, and both groups displayed similar significant increases in carotid artery stiffness compared to lean controls.
Urbina says this suggests that obesity-related artery damage may be occurring long before obesity-related diseases do.
“It appears that this functional abnormality is already present in obese youth well before they go on to develop type 2 diabetes,” she tells WebMD.
The new research appears in the latest issue of the American Heart Association journal Circulation.
It was not clear how abnormal the carotid arteries of the obese and diabetic children, teens, and young adults in the study were because there is little to define normal in these age groups, Urbina says.
“We know what the carotid arteries of someone who is 35 or 40 are supposed to look like, but we are not really sure what they should look like in younger people because this has not been studied,” she says.
Until those studies are done, she says, screening at-risk children for artery damage makes little sense.
“If this does become an effective screening tool, it could help us identify the really high-risk kids who should be on blood pressure drugs or statins [for high cholesterol] or who would benefit from [weight loss] surgery,” she says.
In another recent study, researchers reported that the carotid arteries of obese children and teens whose average age was 13 resembled those of an average 45-year-old.
The lead author of that study tells WebMD that the increasing burden of obesity among children may translate to significantly more heart and vascular disease in as little as a decade.
“We know how to take care of adults with risk factors like high blood pressure and high cholesterol, but we know much less about how to best address these risk factors in children,” says cardiologist and professor of pediatrics Geetha Raghuveer, MD, of the University of Missouri, Kansas City School of Medicine.
Columbia University cardiologist Lee Goldman, MD, and colleagues used a computerized model to predict heart disease incidence in the coming decades. The model suggests that by 2035, 100,000 additional cases of heart disease will occur in the U.S. as a result of the current obesity epidemic.
The finding was published late in 2007 in the New England Journal of Medicine.
Goldman says the newly published research does not prove that heart disease related to obesity and diabetes is occurring earlier in life, but the research as a whole is pointing in that direction.
“This is one more piece of evidence in a logical link that type 2 diabetes in adolescence is looking like type 2 diabetes in adults, and that is bad,” he tells WebMD.
SOURCES:Urbina, E.M., Circulation, June 2009; online edition.Elaine M. Urbina, MD, director of preventive cardiology, Cincinnati Children’s Hospital Memorial Center Heart Institute; associated professor of pediatrics, University of Cincinnati.Lee Goldman, MD, executive vice president for health and biomedical sciences, Columbia University, New York, N.Y. Geetha Raghuveer, MD, cardiologist, Children’s Mercy Hospital, Kansas City, Mo.WebMD Health News: “Forecast: Tsunami of Heart Disease."
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