Common carotid intima-media thickness was measured by B-mode ultrasound imaging in 46 children (mean age, 7.4 years) with serum cholesterol 26.4 mmol/L (mean, 8.25 mmol/L) and in 48 children (mean age, 6.4 years) with serum cholesterol <6.4 mmol/L (mean, 4.60 mmol/L). Maximum thickness was significantly higher in hypercholesterolemic children than in control children (0.50 versus 0.47 mm, P=.007). Subgroup analysis showed that only in children >6.2 years old (the median of all the children's ages) was maximum thickness significantly higher in hypercholesterolemic children than in control children (0.51 versus 0.48 mm, P=.O14). The odds ratio (OR) of common carotid intima-media thickening T he relationship between hypercholesterolemia and coronary artery diseases (CAD) has been proved in adult CAD patients. 1 " 3 The significance of this relationship is more controversial in healthy subjects, particularly if their serum cholesterol is <6.4 mmol/L, 4 -6 Children form a special subgroup of healthy individuals.Population-based or "high-risk"-based screenings for serum cholesterol are usually recommended, 710 although others oppose this view on the basis of potential harm and of nonproven efficacy in the prevention of adult CAD. 1112Autopsy studies on arterial specimens of human subjects have shown that fatty streaks (nonraised lesions) can be found in the aortas even of 3-year-olds 13 and appear in the coronary arteries during the second decade of life.14 More advanced coronary atherosclerosis was seen in a majority of young adults in whom autopsies were performed during the Korean and Vietnam wars. -16 Aortic fatty streaks detected in subjects who had died between full-term birth and age 29 years appeared to be strongly related to antemortem levels of both total and low-density lipoprotein (LDL) cholesterol. 17 Raised lesions, like fibrous plaques, are related to clinical CAD, 18 but the progression of fatty streaks to fibrous plaques is uncertain. Arterial fibrous plaques have been found in autopsy specimens from children, Received October 5, 1993; revision accepted March 25, 1994. From the Institute of Internal Medicine and Metabolic Diseases and the Department of Pediatrics (R.S., A. Di C), Federico II University, Naples, Italy.Correspondence to Dr Paolo Pauciullo, Institute of Internal Medicine and Metabolic Diseases, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy.© 1994 American Heart Association, Inc.(maximum thickness of the far wall higher than the 95th percentile of the control group, 0.51 mm) between patients and control subjects was statistically significant both in univariate analysis (OR, 6.39; 95% confidence interval, 1.19 to 32.3; f>=.025) and after age (OR, 5.96; 95% confidence interval, 1.09 to 32.4; P=.O39) and sex (OR, 7.54; 95% confidence interval, 1.38 to 41.2; P=.02O) were controlled for. Children >6 years old with serum cholesterol ^6.4 mmol/L show increased thickness of the common carotid intima-media.

Childhood obesity is associated with an increased carotid intima-media thickness (IMT) and stiffness. Increased carotid wall thickening and rigidity are considered markers of subclinical atherosclerosis. The aim of the present study was to test the effect of two hypocaloric diets of varying glycemic index on weight loss and markers of subclinical atherosclerosis in obese children. Seventy consecutive obese children attending the Outpatient Weight Clinic of the Department of Pediatrics were invited to participate in an intensive dietary protocol. Twenty-six accepted and were randomly assigned to two different groups: the first group followed a hypocaloric low-glycemic index diet and the second a hypocaloric high-glycemic index diet. Anthropometric measures and biochemical tests were performed in all children. Quantitative B-mode ultrasound scans were used to measure intima-media thickness (IMT) and diameters of the common carotid artery. Considering both groups together, at 6 months, body mass index decreased from 28.3 +/- 3.1 to 25.8 +/- 3.3 kg/m(2), systolic blood pressure from 119 +/- 12 to 110 +/- 11 mmHg (P< 0.001), diastolic blood pressure from 78 +/- 8 to 74 +/- 7 mmHg (P< 0.001), IMT from 0.48 +/- 0.05 to 0.43 +/- 0.07 mm (P< 0.001), stiffness from 3.57 +/- 1.04 to 2.98 +/- 0.94 mm (P = 0.002), and high-sensitivity C-reactive protein from 1.5 +/- 0.9 (values log transformed) to 0.4 +/- 1.1 (P < 0.001). No differences were detectable in fasting serum triglycerides, total cholesterol, and high-density lipoprotein cholesterol. Insulin resistance (calculated by the HOmeostatic Model Assessment index [HOMA] score) significantly reduced only in the low-glycemic-index diet group (P < 0.04). In conclusion, this study confirms a benefit of hypocaloric diets on carotid IMT and stiffness in obese children and demonstrates, for the first time, an amelioration of insulin sensitivity in obese children after a low-glycemic index diet. These results justify the advice to obese children to follow a low-glycemic index diet in order to improve their cardiometabolic profile.

Background and Purpose-Studies on cardiovascular disease have preferentially involved men because of the lower frequency of the disease in preelderly women. The aim of this analysis was to examine, with the use of a standardized ultrasound protocol, a cohort of women to differentiate early atherosclerotic lesions in different carotid segments in relation to traditional (lipoprotein abnormalities, high blood pressure, cigarette smoking) and nontraditional (oxidation markers) cardiovascular risk factors. Methods-More than 5000 clinically healthy, middle-aged women (nϭ5062; age range, 30 to 69 years) living in the area of Naples in southern Italy participated in the Progetto Atena, a population-based study on the etiology of cardiovascular disease and cancer in the female population. A subsample of 310 participants underwent high-resolution B-mode ultrasound to assess intima-media thickness of common carotid artery and carotid bifurcation. Results-Early atherosclerotic plaques (intima-media thickness Ͼ1.2 mm) were detected within the common carotid arteries in 37 women, in the carotid bifurcations in 77 women, and in both sites in 91 women. After age adjustment, common carotid plaques were found to be associated with higher systolic blood pressure (143 versus 138 mm Hg; PϽ0.05) and higher body mass index (29 versus 27 kg/m 2 ; PϽ0.01), while lesions at the carotid bifurcations were associated with higher LDL cholesterol (4.3 versus 3.8 mmol/L; PϽ0.01) and with smoking habit. Multivariate odds ratios for the presence of common carotid plaques were related to antibodies against oxidized LDL (odds ratio, 2.72; 95% CI, 1.46 to 5.07), and those for plaques at the bifurcation were related to lipid peroxides (odds ratio, 1.90; 95% CI, 1.04 to 3.47), and both relationships were independent of age, LDL cholesterol concentrations, body mass index, smoking habit, and systolic blood pressure. Conclusions-In a cohort of clinically healthy, middle-aged women, we found a site-specific association of traditional risk factors and oxidation markers with early atherosclerotic lesions in arterial segments differing in geometry, shear stress, extracellular matrix composition, and cell type populations.

An inverse association was found between both the intake amount and plasma concentration of vitamin E and preclinical carotid atherosclerosis in middle-aged women. This association was independent of other cardiovascular risk factors, was not related to vitamin supplements, and supports the hypothesis that low vitamin E intake is a risk factor for early atherosclerosis.

Preclinical vascular changes (increased stiffness and/or wall thickness) have been observed in children with known metabolic risk factors. Aim of the present study was to evaluate different carotid parameters, representative of vascular health, in children with and without metabolic syndrome (MS). We studied 38 children with MS (mean age 9.672.6 years; range 6-14 years) and 45 healthy age-matched subjects. Children who met three or more of the following criteria qualified as having the MS: fasting glucose 4110 mg dl À1 , fasting triglyceride concentration 4100 mg dl À1 , fasting high-density lipoprotein cholesterol concentration o50 mg dl À1 for females or o45 mg dl À1 for the males, waist circumference 475th percentile for age and gender and systolic or diastolic blood pressure 490th percentile for age, gender and height. Carotid B-mode ultrasound examinations were performed and intima-media thickness and diameters were measured in all subjects. Arterial geometry was further characterized by calculation of carotid cross-sectional area. Carotid intimamedia thickness and lumen diameters were increased in children with MS as compared to children without MS. Moreover, carotid cross-sectional area was significantly higher in the group of children with MS 9.8371.86 mm 2 [mean7s.d.] compared with the control group: 7.7771.72 mm 2 , Po0.001, even after adjustment for age, gender and height. Carotid hypertrophy is already detectable in children with MS. High-resolution B-mode ultrasound could provide a valuable tool for the cardiovascular risk stratification of children.