Cardiovascular risk factors in adults with coarctation of the aorta

Abstract

Background The aging patient with adult congenital heart disease (ACHD) faces the risk of developing atherosclerotic disease. Patients with coarctation of the aorta (CoA) are especially vulnerable because of an inherent high risk of developing hypertension. However, data on the prevalence of other cardiovascular risk factors are scarce. Therefore, this study aimed to describe the prevalence of traditional cardiovascular risk factors (diabetes, hypertension, hyperlipidemia, smoking, obesity, and sedentary lifestyle) in adult patients with CoA. Methods Patients with CoA who were registered at the ACHD clinic in Gothenburg were asked to participate in a comprehensive cardiovascular risk assessment. This assessment included a glucose tolerance test, cholesterol profile, ambulatory blood pressure measurements, and a lifestyle questionnaire. Results A total of 72 patients participated. The median age was 43.5 years and 58.3% were men. Sixty‐six (91.7%) patients had ≥one cardiovascular risk factor and 40.3% had ≥three risk factors. Three (4.2%) patients were newly diagnosed with diabetes or impaired glucose tolerance. More than half of the patients had hyperlipidemia (n = 42, 58.3%) and 35 patients (48.6%) were overweight or obese. Only three (4.2%) patients smoked regularly. Of the 60 patients who underwent 24‐hour ambulatory blood pressure measurement, 33 (55.0%) were hypertensive. Of the 30 patients with known hypertension only 9 (30.0%) had well‐controlled blood pressure on ambulatory blood pressure measurement. Conclusions Cardiovascular risk factors among patients with CoA are prevalent. This may indicate a need for more aggressive screening strategies of traditional risk factors to minimize the risk of these patients also developing atherosclerotic disease.

Cardiovascular Risk Factors among Outpatients: An Alarming Sign of the Epidemiological Transition in Developing Country?

“…This cross-sectional study aimed to describe the cardiovascular disease risk factors among outpatients by consecutive recruitment from April to November 2017. [12], however, the proportion of male sex 58.3% in this study was in the opposite sense of our sex-ratio. Data about the median age of several cardiovascular risk assessment studies showed that the incidence of cardiovascular diseases over time has been steady or has increased in young adults [13].…”

“…Across the Atlantic,Peter WF, et al, 2002 [18] in a study of the determinants of cardiovascular risk (CVR) showed that high population attributable risks were related to excess weight (BMI ≥ 25) for the outcomes hypertension (26% men; 28% women), angina pectoris (26% men; 22% women), and coronary heart disease (23% men; 15% women). In the same range, Maria Fedchenko, et al, 2019[12] found that 48.6% of adult patients with coarctation of the aorta were overweight or obese. The prevalence of smoking among our patients was 14.04%.…”

Overweight and Obesity in Patients with Congenital Heart Disease: A Systematic Review

“…Twenty-six of the included studies were cross-sectional studies that examined the prevalence of overweight and obesity in patients with CHD [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ], and four were cohort studies that investigated the longitudinal change of the prevalence across the lifespan [ 10 , 43 , 44 , 45 ]. The body composition of patients with CHD was compared to a healthy reference cohort in 13 of the included studies [ 20 , 21 , 22 , 23 , 24 , 28 , 29 , 30 , 33 , 35 , 40 , 41 , 45 ], whereas 9 studies merely investigated the prevalence of overweight and obesity in patients with CHD [ 10 , 17 , 18 , 19 , 24 , 32 , 36 ,…”

“…The included studies in this review controlled for age [ 21 , 24 , 35 , 37 , 39 ], age and lesion severity [ 27 ], age and sex [ 10 , 17 , 18 , 20 , 23 , 28 , 31 , 33 , 36 , 38 , 40 , 41 , 43 , 44 ], race/ethnicity [ 29 , 45 ], family history, parent’s nutritional status [ 19 ], marital status, educational level, and geographic region [ 34 ]. Six studies did not take confounders into account and were therefore rated as “poor” [ 8 , 22 , 25 , 26 , 37 , 42 ]. Comprehensive information on the quality rating can be found in Table 2 .…”

Improving growth of infants with congenital heart disease using a consensus-based nutritional pathway

“…Although, the fall in WAZ between birth and both 4 and 12 months-of-age were significantly reduced in the intervention group compared to the control group, it is important to note that weight gain alone or improved weight for height does not indicate nutritional rehabilitation in the presence of stunting or low height for age, as it suggests there is insufficient nutrients to support linear growth, resulting in overweight stunted children [31], which is increasingly reported in older children with CHD [32]. As such improving linear growth during the first year of life is a priority and may reduce cardiovascular risk in later life [33]. In this study linear growth at 12 months-of-age was significantly improved in infants with CHD who followed the pre-operative nutrition pathway, when compared to a historic control.…”