title: Coronary artery calcification in obese youth: what are the phenotypic and metabolic determinants?
abstract: OBJECTIVE
  Obesity in adolescence has been associated with increased risk for coronary heart disease in adulthood. This study evaluated subclinical atherosclerosis in obese youth and the underlying risk factors.
  
  
  METHODS
  Ninety obese adolescents (37 normal glucose tolerant, 27 prediabetes, and 26 type 2 diabetes) underwent evaluation of coronary artery calcifications (CACs) by electron beam computed tomography, aortic pulse wave velocity (PWV), carotid intima-media thickness (IMT), lipids, leptin, inflammatory markers, and body composition (DEXA). A total of 68 underwent evaluation of insulin sensitivity (IS) (hyperinsulinemic-euglycemic clamp) and abdominal adiposity (computed tomography).
  
  
  RESULTS
  A total of 50% had CACs (CAC+: Agatston CAC score ≥1). CAC+ youth had higher BMI, fat mass, and abdominal fat, with no difference in sex, race, IS per fat-free mass (ISFFM), glucose tolerance, PWV, or IMT compared with the CAC- group. PWV was inversely related to IS. In multiple regression analyses with age, race, sex, HbA1c, BMI (or waist circumference), ISFFM, diastolic blood pressure, non-HDL cholesterol, and leptin as independent variables, BMI (or waist) (R(2) = 0.41; P = 0.001) was the significant determinant of CAC; leptin (R(2) = 0.37; P = 0.034) for PWV; and HbA1c, race, and age (R(2) = 0.34; P = 0.02) for IMT.
  
  
  CONCLUSIONS
  Early in the course of obesity, there is evidence of CAC independent of glycemia. The different biomarkers of subclinical atherosclerosis appear to be differentially modulated, adiposity being the major determinant of CAC, hyperglycemia, age, and race for IMT, and leptin and IS for arterial stiffness. These findings highlight the increased cardiovascular disease risk in obese youth and the need for early interventions to reverse obesity and atherosclerosis.
authors.affiliation: Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX fbacha@bcm.edu.
authors.forename: Fida
authors.initials: F
authors.lastname: Bacha
authors.affiliation: Department of Medicine, Section of Cardiology, Temple University, Philadelphia, PA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Edmundowicz
authors.affiliation: School of Public Health, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Kim
authors.initials: K
authors.lastname: Sutton-Tyrell
authors.affiliation: Weight Management and Wellness Center, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA.
authors.forename: SoJung
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, American University of Beirut, Beirut, Lebanon.
authors.forename: Hala
authors.initials: H
authors.lastname: Tfayli
authors.affiliation: Weight Management and Wellness Center, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA.
authors.forename: Silva A
authors.initials: SA
authors.lastname: Arslanian
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000378:metabolism*; D002114:Calcinosis / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D059168:Carotid Intima-Media Thickness; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D009765:Obesity / Q000150:complications*; D063177:Pulse Wave Analysis; D059289:Vascular Stiffness
chemical_list: D015415:Biomarkers