Epidemiology of Carotid Artery Atherosclerosis in Youth

描述(申请人提供)：动脉粥样硬化的过程开始于儿童时期，在腹主动脉远端出现脂肪条纹，后来影响颈动脉和冠状动脉。识别出动脉粥样硬化的高危儿童和青少年将允许在出现症状之前进行早期干预。测量颈动脉内中膜厚度(IMT)可检测亚临床疾病，并可预测老年人的冠状动脉疾病、中风和外周血管疾病。1970年，在爱荷华州马斯卡廷的学龄儿童中测量了心血管危险因素(CRF)。在最初的队列中，有代表性的675名成员现在的年龄在42岁到50岁之间。风险因素在儿童期、成年期和三倍于老年人时进行了测量。此外，亚临床疾病的测量包括颈动脉内膜厚度、冠状动脉钙化(CAC)和肱动脉血流介导的扩张已经完成。年轻人和中年人的颈动脉IMT与儿童时期的危险因素有关，包括男女的胆固醇和女性的肥胖。颈动脉IMT与CAC和当前CRF显著相关。在该队列的442名15-30岁的子代中，颈动脉IMT与CRF无关，但子代CRF与双亲颈动脉IMT相关。兄弟姐妹间颈动脉IMT与亲代IMT相关，提示颈动脉IMT存在家族聚集性。在这项应用中，我们将测量早期受动脉粥样硬化影响的血管床、腹主动脉远端以及颈动脉的IMT。在662名11~32岁的子代中，我们将确定(1)主动脉和颈动脉IMT是否相关，(2)CRF与主动脉IMT的关系和颈动脉IMT的进展，以及(3)子代的主动脉和颈动脉IMT与父母亚临床(根据颈动脉IMT的进展)或临床(心血管发病率或死亡率)疾病的关系。这项建议有可能提供信息，使人们能够确定儿童或青少年时期动脉粥样硬化的高危人群。

DESCRIPTION (provided by applicant): The atherosclerotic process begins in childhood with the appearance of fatty streaks in the distal abdominal aorta and later affects the carotid and coronary arteries. Identification of children and adolescents at high risk for atherosclerosis would allow early intervention before the development of symptoms. Measurement of carotid intimal-medial thickness (IMT) detects subclinical disease and is predictive of coronary artery disease, stroke and peripheral vascular disease in older adults. In 1970, cardiovascular risk factors (CRF) were measured in school age children in Muscatine, Iowa. A representative sample of 675 members of this initial cohort are now aged 42 to 50 years. Risk factors were measured in childhood, young adulthood, and three times as older adults. In addition, measures of subclinical disease including carotid IMT, coronary artery calcification (CAC) and brachial artery flow-mediated dilatation have been completed. Carotid IMT in young and middle-aged adults is related to childhood risk factors including cholesterol in both genders and obesity in women. Carotid IMT is significantly associated with CAC and current CRF. In 442 of the offspring of this cohort, aged 15 to 30 years, carotid IMT is not related to CRF but CRF in the offspring are related to parental carotid IMT. Carotid IMT is correlated within siblings and with parental IMT suggesting that there is familial aggregation of carotid IMT. In this application, we will measure IMT in a vascular bed affected earlier by atherosclerosis, the distal abdominal aorta, as well as in the carotid artery. In 662 offspring, aged 11 to 32 years, we will determine (1) if aortic and carotid IMT are related (2) the relationship of CRF to aortic IMT and progression of carotid IMT and (3) the relationship of aortic and carotid IMT in the offspring to subclinical (as measured by progression of carotid IMT) or clinical (cardiovascular morbidity or mortality) disease in their parents. This proposal has the potential of providing information which would allow identification of individuals at high risk of atherosclerosis during childhood or adolescence.