CV impairment in obese adolescents may point to future health burdens

SAN FRANCISCO — Diastolic function of the left ventricle was impaired in overweight and obese youth compared with controls, suggesting potential risk for future cardiovascular disease in adulthood, Gary M. Leong, MB, BS, FRACP, PhD, told Endocrine Today here at ENDO 2013.

Perspective from Nancy Crimmins, MD

“We should be looking more closely at these adolescents to make sure we investigate their cardiovascular function by doing this relatively standardized measure of cardiac structure function,” the associate professor and senior academic fellow in child obesity research and chronic disease prevention at the University of Queensland, Mater Children’s Hospital in South Brisbane, Australia, said.

Gary M. Leong

In their evaluation of obese youth and adverse CV structure, data indicate that the overweight and obese youth (n=35) displayed higher fasting insulin, high-sensitivity C-reactive protein (hs-CRP), triglycerides and cholesterol (all P<.001), LDL (P=.001) and lower HDL (P<.05), compared with controls (n=30).

According to data, insulin resistant overweight youth (n=16) had higher hs-CRP and resistin (P<.01 for both); interleukin (IL)-6 (P<.05); IL-1 receptor agonist and leptin (both P<.001); and lower adiponectin (P<.001) compared with controls and non-insulin resistant overweight youth (n=19).

Leong added that diastolic function was impaired in insulin resistant overweight youth compared with controls, based on lower EA ratio (ratio of early and late diastolic left ventricular [LV] filling; P<.05) and septal E prime (LV myocardial elasticity; P<.001) and higher E/e’ (LV filling pressures; P<.001).

Septal E prime and E/e’ were markedly related to BMI and waist circumference and height (all P<.001). Further, septal E prime was significantly associated with insulin adiponectin (both P=.005), hs-CRP, leptin and resistin (all P<.05), according to data.

“In adults, these conglomerations of heart changes detectable by echocardiograms are associated with predicting long-term risk of congestive heart failure. To actually see these changes in a 15-year-old who’s insulin resistant, without prediabetes or diabetes, is a very worrying portent of their long-term cardiovascular health,” Leong said.

Leong added that he and his colleagues are in the process of designing a prospective study where they will identify adolescents with abnormal cardiac findings and determine whether the findings from the current study can be reversible through cardiac fitness. – by Samantha Costa

For more information:

Leong GM. #SAT-693. Presented at: The Endocrine Society Annual Meeting and Expo; June 15-18, 2013; San Francisco.

Disclosure: Leong reports no relevant financial disclosures.

Perspective

Nancy Crimmins, MD

As an obesity provider at a children’s hospital, I can tell you that many cardiologists are interested in conducting an echocardiogram on every patient. However, it’s not very cost-effective to do so.

If you can identify which insulin resistant children are the patients you need to target, or any other factor that helps you figure out who would benefit from an echocardiogram and who wouldn’t, it’s a helpful thing to know.

I also think it’s hard to tease out what it is specifically about the insulin resistant children that puts them at risk, but from a clinician’s standpoint, it makes your job a lot easier to figure out who might need one and who may not.

Nancy Crimmins, MD

Assistant Professor of PediatricsDivision of Endocrinology

Cincinnati Children’s Hospital Medical Center

Disclosures: Crimmins reports no relevant financial disclosures.