title: Subclinical atherosclerosis and ambulatory blood pressure in children with metabolic syndrome.
abstract: BACKGROUND
  The metabolic syndrome (MS) has reached epidemic proportions worldwide. This syndrome is associated with cardiovascular risk factors, including functional and structural cardiac and vascular changes. The aim of our study was to evaluate subclinical atherosclerosis and its associated risk factors in children with MS.
  
  
  METHODS
  The study cohort comprised 52 children with MS and 38 age- and sex-matched healthy children. The diagnosis of MS was made according to criteria adopted by the World Health Organization. Blood pressure based on 24-h ambulatory blood pressure monitoring (ABPM), carotid intima-media thickness (cIMT), carotid distensibility coefficient (DC) and flow-mediated endothelium-dependent dilation (EDD) were assessed in all children.
  
  
  RESULTS
  We found a significantly higher cIMT in children with MS than in healthy children, but carotid DC and flow-mediated EDD were lower in the former. Multivariate analysis revealed that a higher cIMT was independently associated with a higher nighttime systolic blood pressure (SBP) and lower high-density lipoprotein-cholesterol (β = 0.386, p = 0.011 and β = 0.248, p = 0.042, respectively). Also, higher nighttime SBP remained an independent predictor of lower DC (β = 0.495, p = 0.009), and higher 24-h SBP was the only independent predictor for a lower EDD (β = 0.532, p = 0.004).
  
  
  CONCLUSIONS
  Atherosclerotic vascular changes were common among our pediatric patients with MS and easily determined by high-resolution ultrasound imaging. In particular, subclinical atherosclerosis was clearly associated with nocturnal or 24-h systolic hypertension as measured by ABPM. We therefore recommend that subclinical vascular changes and AMBP measurements should be used as diagnostic markers to predict atherosclerotic risks in this pediatric patient group.
authors.affiliation: Department of Pediatric Nephrology, Haseki Educational and Research Hospital, Istanbul, Turkey, drcivilibal@hotmail.com.
authors.forename: Mahmut
authors.initials: M
authors.lastname: Civilibal
authors.forename: Nilgun Selcuk
authors.initials: NS
authors.lastname: Duru
authors.forename: Murat
authors.initials: M
authors.lastname: Elevli
mesh_terms: D000293:Adolescent; D050197:Atherosclerosis / Q000150:complications / Q000503:physiopathology*; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D059168:Carotid Intima-Media Thickness; D002648:Child; D002940:Circadian Rhythm; D015331:Cohort Studies; D004730:Endothelium, Vascular / Q000503:physiopathology; D005260:Female; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012307:Risk Factors
chemical_list: D008055:Lipids