title: Premature subclinical atherosclerosis in pediatric inflammatory bowel disease.
abstract: OBJECTIVE
  To investigate the risk for developing an early endothelial dysfunction based on increased intima media thickness (IMT) and reduced flow-mediated dilation (FMD) in children with inflammatory bowel disease (IBD), and to evaluate the role of traditional and nontraditional risk factors in determining premature atherosclerosis.
  
  
  METHODS
  We studied 27 patients with Crohn's disease (CD) and 25 patients with ulcerative colitis (UC) (mean age, 15.2 years; mean duration of disease, 48.05 months); 31 subjects served as controls. Demographic data (age, sex, family history of diabetes, cardiovascular disease, hypertension, hypercholesterolemia), traditional risk factors for atherosclerosis (blood pressure, body mass index, active and passive smoking, dyslipidemia), and UC and CD activity indexes (Pediatric Ulcerative Colitis Activity Index and Pediatric Crohn's Disease Activity Index, respectively) were collected. The IMT of the carotid arteries was measured by high-resolution B-mode ultrasound, and endothelial function was evaluated by FMD in the brachial artery in response to reactive hyperemia.
  
  
  RESULTS
  Compared with controls, patients with CD had significantly greater exposure to passive smoking and had lower body mass index and high-density lipoprotein cholesterol values. IMT was significantly higher in patients than controls (P < .0001), and the percentage of FMD was significantly lower in both patients with CD (P < .0001) and patients with UC (P < .01) versus controls. In multivariate analysis, diagnosis of IBD was an independent risk factor for atherosclerosis.
  
  
  CONCLUSIONS
  Premature endothelial dysfunction occurs in pediatric IBD. This represents a new challenge in the management of pediatric IBD, leading to prevention strategies of cardiovascular disease.
authors.affiliation: Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Aloi
authors.forename: Luciana
authors.initials: L
authors.lastname: Tromba
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Nardo
authors.forename: Anna
authors.initials: A
authors.lastname: Dilillo
authors.forename: Emanuela
authors.initials: E
authors.lastname: Del Giudice
authors.forename: Elisa
authors.initials: E
authors.lastname: Marocchi
authors.forename: Franca
authors.initials: F
authors.lastname: Viola
authors.forename: Fortunata
authors.initials: F
authors.lastname: Civitelli
authors.forename: Alberto
authors.initials: A
authors.lastname: Berni
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cucchiara
mesh_terms: D000293:Adolescent; D000328:Adult; D050197:Atherosclerosis; D001916:Brachial Artery / Q000473:pathology; D059168:Carotid Intima-Media Thickness; D002648:Child; D003093:Colitis, Ulcerative / Q000473:pathology / Q000503:physiopathology*; D003424:Crohn Disease / Q000473:pathology / Q000503:physiopathology*; D004108:Dilatation, Pathologic; D004730:Endothelium, Vascular / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D055815:Young Adult