The Investigation Of The Clinical Assessment Of Cardiovascular Risk In Obese Children

Objective1. To investigate the subclinical atherosclerosis and obesity cardiomyopathy in obese children.2. To observe the three different definitions defined by the indexes of National Health and Nutrition Examination survey (NHANES), National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) and the definition of metabolic syndrome and prophylaxis and treatment proposal in Chinese children and adolescents, such as LHDL-C, HLDL-C, HTG, HFPG and HBP, and to compare the clinical application of the there definitions to assess the clustering of cardiovascular risk factors in obese children.3. To elaborate the relationship between non-HDL-C, remnant cholesterol, AIP and atherosclerosis, and then to determine the optimal non-HDL-C, remnant cholesterol and AIP cut-off values for predicting clustering of three or more cardiovascular risk factors.Methods1. A total of624obese children were enrolled in this trial including51obese children who performed carotid ultrasound and ultrasonic cardiogram examination.621healthy children whose age and sex were matched served as the control group including27healthy children who performed carotid ultrasound and ultrasonic cardiogram examination. The Physical parameters and biochemical indicators of the two groups were compared.2. The carotid intima-media thickness (c-IMT), inner diameter, peak flow velocity of the carotid artery of the obese children and the healthy children were compared. And then the relationship between the physical parameters, biochemical indicators and all the indicators of carotid ultrasound examination above of the obese children were analyzed.3. The left ventricular end-diastolic diameter (LVEDd), left ventricular posterior wall thickness (LVPWT), interventricular septal thickness (IVST), left ventricular mass index (LVMI), Tei index of the obese children and the healthy children were compared. And the relationship between the physical parameters, biochemical indicators and all the indicators of ultrasonic cardiogram examination above of the obese children were also analyzed.4. The frequencies of clustering of cardiovascular risk factors and every cardiovascular risk factor in obese group were calculated by the three different definitions of clustering of cardiovascular risk factors, and the consistent degree diagnosing the clustering of cardiovascular risk factors among the three definitions was analyzed by Chi-square.5. Then the optimal cut-off values of non-HDL-C, remnant cholesterol and AIP for predicting clustering of three or more cardiovascular risk factors were determined by receiver operating characteristics (ROC) analysis.Results1. The physical parameters and the biochemical indicators except HDL-C in the obese group were significantly higher than those of the control group (P<0.01), but HDL-C of the obese group was lower than that of the control group (P<0.01).2. The intima-media thickness (c-IMT), inner diameter, peak flow of the carotid artery of the obese children were significantly higher than those of the healthy children (P<0.01).3. Bilateral c-IMT were positively correlated with body weight, BMI, WC, HOMAIS, SP and LD, and were negatively correlated with QUICKI and WBISI (P<0.05, or P<0.01). The Lc-IMT also showed a positive correlation with HOMAIR (P<0.05). Bilateral carotid artery diameters were positively correlated with body weight, BMI, WC was, and were negatively correlated with HDL-C and WBISI (P<0.05, or P<0.01). Bilateral carotid artery peak flow velocity had no significant correlation with every indicator.4. The left ventricular end-diastolic diameter (LVEDd), left ventricular posterior wall thickness (LVPWT), interventricular septal thickness (IVST), left ventricular mass index (LVMI) and Tei index were significantly higher than those of the healthy children (P<0.01).5. The results diagnosing the clustering of cardiovascular risk factors among the three definitions analyzed by Chi-square:Male, chi-square value is2.491, P value is0.288, P>0.05; female, chi-square value was0.094, P value was0.934, P>0.05. The results diagnosing the clustering of cardiovascular risk factors among the three definitions analyzed in obese group by Chi-square:chi-square value was1.602, P>0.05.6. The detection rate of LHDL-C detected by definition2was higher than those detected by definition1and by definition3. The detection rate of HTG detected by definition1was higher than those detected by definition2and by definition3. The detection rates of HFPG and HBP detected by definition3were higher than those detected by definition1and by definition2. Chi-square:the detection rate of abnormal numbers of components detected by the three different definitions had no significantly statistical difference (P>0.05). The detection rates of HTG had significantly statistical difference (P<0.01), but not between definition1and definition3(P>0.05). The detection rate of HFPG had significantly statistical difference (P<0.01). The detection rates of HBP and LHDL-C had no significantly statistical difference (P>0.05).7. The optimal cut-off values of non-HDL-C for predicting clustering of three or more cardiovascular risk factors based on three different definitions were:male3.11and female3.05, male3.11and female3.05, male3.12and female3.05, sensitivity is ranged from0.8to1.0, specificity is ranged from0.5to0.7, AUC is ranged from0.7to0.8; the optimal cut-off values of remnant cholesterol for predicting clustering of three or more cardiovascular risk factors based on three different definitions were: male0.56and female0.67, male0.77and female0.76, male0.66and female0.63, sensitivity was ranged from0.6to0.9, specificity was ranged from0.5to0.8, AUC was ranged from0.6to0.8; the optimal cut-off values of remnant cholesterol for predicting clustering of three or more cardiovascular risk factors based on3different definitions were:male0.04and female0.09, Male0.17and female0.14, Male0.15and female0.14, sensitivity was ranged from0.7to0.9, specificity was ranged from0.5to0.8, and AUC was ranged from0.7to0.9. The optimal cut-off values of non-HDL-C had a higher consistency. The optimal cut-off value of remnant cholesterol had a higher specificity and sensitivity in male0.66and female0.63, and the AUC was also the largest. The optimal cut-off value of AIP had a higher sensitivity, specificity, and AUC in male0.15and female0.14. 8. The detection rates of the clustering of cardiovascular risk factors in the obese group after the optimal cut-off values of non-HDL-C, remnant cholesterol and AIP were higher than those in the group before the optimal cut-off values, all of chi-square P values were less than0.05.Conclusion1. The obese children have subclinical atherosclerosis and obesity cardiomyopathy, expressed respectively as c-IMT thickening and left ventricular structure and function abnormalities.2. The detection rates of the clustering of cardiovascular risk factors detected by the three definitions had a higher consistent degree.3. The detection rate of the clustering of cardiovascular risk factors detected by definition3was highest among the three definitions, and the detection rates of HFPG and HBP detected by definition3were higher than those detected by definition1and by definition2, so definition3was more suitable for the evaluation of the clustering of cardiovascular risk factors in Chinese obese children.4. non-HDL-C, remnant cholesterol and AIP could predict the clustering of cardiovascular risk factors. The optimal cut-off values of non-HDL-C, remnant cholesterol and AIP for predicting the clustering of cardiovascular risk factors were male3.11mmol/L、female3.05mmol/L, male0.66mmol/L and female0.63mmol/L, male0.15and female0.14.