Childhood Obesity Increases Vascular Aging
Presented by Geetha Raghuveer, MD, MPH
One in three American children is overweight, a statistic that Geetha Raghuveer, MD, MPH, finds unacceptable. Dr. Raghuveer is a specialist in Pediatric and Preventive Cardiology at Children’s Mercy and Associate Professor of Pediatrics at the University of Missouri-Kansas City School of Medicine.
Inspired by her mentor, the late Ronald M. Lauer, MD, of the University of Iowa, Dr. Raghuveer dedicates much of her practice to prevention of life-shortening health problems in children. Childhood obesity and co-existing risk factors that also affect the cardiovasculature, such as dyslipidemia, hypertension and diabetes, can result in premature cardiovascular disease or death.
Dr. Raghuveer co-authored a study presented to the American Heart Association in 2008 and later published in its journal, Circulation, Cardiovascular Imaging. The research, titled “‘Vascular Age’ is Advanced in Children With Atherosclerosis-Promoting Risk Factors,” acknowledged that obesity and genetic dyslipidemia in children are associated with accelerated atherosclerosis. The authors investigated whether these children, average age 13 years, had increased carotid artery intima-media thickness (CIMT), a marker of atherosclerosis.
Utilizing carotid artery ultrasound, they compared the child’s CIMT against a race- and sex-matched 45-year-old and concluded that the child’s vascular age was advanced and comparable to that of a middle-aged adult. “Advanced vascular age was prevalent in obese children with high triglyceride levels resulting from excessive consumption of sugary beverages and foods,” says Dr. Raghuveer.
In May, Dr. Raghuveer and colleagues presented a paper to the Pediatric Academy Society titled, “Increased Body Mass Index in Children is High-risk for Cardiac Damage.” In this study of more than 2,000 children aged 10 to 18 years with varying body mass indices, obesity in children was found to be an overriding risk for cardiac damage.
“The mass of the left ventricle increases as a child goes from being lean to just overweight. If this persists, the blood supply to the heart muscle may not keep pace with increased mass, and unmet demands on the left ventricle may lead to heart disease,” Dr. Raghuveer says.
“My interest is to examine blood vessels non-invasively, assessing for both functional and structural damage, to evaluate their compliance i.e., how easily they expand to blood volume in children with risk factors,” she says.
She is further assessing if CIMT decreases when children lose weight, exercise, or are treated for dyslipidemia. “These changes don’t occur quickly, especially CIMT. Still, we hope that reversal can occur once obesity and risk factors are controlled as vessel build-up in children is not hardened and calcified.”
Dr. Raghuveer remains optimistic. “We physicians can be facilitators, catalysts and advocates to convey the impact that childhood obesity has on cardiovascular mortality and morbidity in the public health arena,” she says. “We can’t solve it all within the four walls of a clinic. Even with the best resources, the best of intentions, the willingness to change must come from the family—not just the child. This is not purely a medical problem. The environment that facilitates obesity is a social and economic problem.”