Background-Obesity is generally accepted as a risk factor for premature atherosclerosis. Subclinical inflammation as quantified by blood levels of C-reactive protein (CRP) contributes to the development and progression of atherosclerosis. We hypothesized that inflammation in obese children is related to functional and early morphological vascular changes. Methods and Results-Blood levels of high sensitivity (hs) CRP, hsIL-6, the soluble intercellular adhesion molecule1 (ICAM-1), vascular cell adhesion molecule (VCAM)-1, and E-selectin were measured in 145 severely obese (body mass index [BMI], 32.2Ϯ5.8 kg/m 2 ) and 54 lean (BMI, 18.9Ϯ3.2 kg/m 2 ) children 12Ϯ4 years old. Flow-mediated dilation (FMD) of the brachial artery and carotid intima-media thickness (IMT) measured by high-resolution ultrasound as markers of early vascular changes were assessed in 92 (77 obese and 15 lean) and 59 (50 obese and 9 lean) children, respectively. Obese children had significantly higher levels of hsCRP, hsIL-6, and E-selectin than healthy controls (4.1Ϯ4.8 versus 0.9Ϯ1.5 mg/L, PϽ0.001 for hsCRP; 1.99Ϯ1.30 versus 1.42Ϯ1.01 pg/mL, Pϭ0.05 for hsIL-6; and 78Ϯ38 versus 59Ϯ29 ng/mL, Pϭ0.01 for E-selectin). There were no differences in the levels of ICAM-1 and VCAM-1 between groups. Obese children had lower peak FMD response (7.70Ϯ6.14 versus 11.06Ϯ3.07%, Pϭ0.006) and increased IMT (0.37Ϯ0.04 versus 0.34Ϯ0.03 mm, Pϭ0.03) compared with controls. Morbidly obese children (nϭ14, BMI 44.1Ϯ3.9 kg/m 2 ) had highest levels of hsCRP (8.7Ϯ0.7 mg/L), hsIL-6 (3.32Ϯ1.1 pg/mL), and E-selectin (83Ϯ40 ng/mL). Conclusions-A proinflammatory state is detectable in obese children, which is accompanied by impaired vascular endothelial function and early structural changes of arteries, even in young subjects at risk. It remains to be determined whether high hsCRP in obese children predicts cardiovascular events.

Genetic risk factors for restenosis after percutaneous transluminal angioplasty have not been investigated. In this patient population, short repeat alleles of the heme oxygenase-1 gene promoter polymorphism were associated with reduced postdilation restenosis at 6 months. Upregulation of HO-1 may be an important protective factor after balloon angioplasty by inhibition of vascular smooth muscle cell proliferation.

Elective carotid stenting can be performed with excellent technical success, an acceptable frequency of periprocedural complications, and good intermediate-term patency. However, our findings suggest that a larger number of interventions should be performed to overcome the negative effects of the initial learning phase.

Sufficient rate control can be achieved in critically ill patients with atrial tachyarrhythmias using either diltiazem or amiodarone. Although diltiazem allowed for significantly better 24-hr heart rate control, this effect was offset by a significantly higher incidence of hypotension requiring discontinuation of the drug. Amiodarone may be an alternative in patients with severe hemodynamic compromise.