Down's syndrome: an atheroma-free model?

Abstract

SummaryPostmortem examination offive institutionalised patients with Down's syndrome (DS) aged 40-66 years showed a complete absence of atheroma, while a similar number of mental defectives without DS were found to have mild or severe atheroma. Previous investigation of risk factors for atheroma in 70 patients with DS and 70 ageand sex-matched mental defectives living in the same institution showed significantly lower systolic and diastolic blood pressures in the DS group, with the exception of systolic pressure in men under 40. Fasting serum cholesterol and triglyceride concentrations were similar in the two groups, but triglyceride concentrations were significantly lower than in normal people without a history of vascular disease. These unexplained observations may be relevant in further studies of the pathogenesis of atheroma.

Lipid Profiles of Children With Down Syndrome Compared With Their Siblings

“…Other studies of lipid and lipoprotein concentrations in individuals with DS have produced varying results ranging from no significant difference in cholesterol, triglycerides, and lipoprotein levels between DS and non-DS groups to reports of increased serum cholesterol, triglycerides and oxidatively modified LDL. [4][5][6][7][8]21 Our study is the first to use exclusively sibling controls to show all measured lipid parameters to be less favorable in the DS group after adjustment for important confounding factors.…”

“…Previous studies comparing lipid and lipoprotein concentrations in individuals with DS with individuals without DS have produced conflicting results. [4][5][6][7][8] Additionally, it is unclear if individuals with DS have a particularly atherogenic lipid profile before developing obesity and diabetes.…”

“…4 Results of postmortem studies that found individuals with DS to have no atherosclerotic plaques, decreased frequency of arteriosclerosis, or decreased total area of raised lesions compared with non-DS controls are cited in the literature. 4,9,10 However, there are conflicting reports that do not support describing DS as an atheroma-free model of disease. In examining autopsy material of institutionalized children ,21 years of age with intellectual disability (ID), slightly more atherosclerosis was found in the coronary arteries and aortas of persons with DS in comparison with other residents with ID.…”

Cardiovascular disease prevalence and risk factors of persons with mental retardation

“…The prevalence of congenital cardiovascular diseases is high in persons with Down syndrome; however, the focus of this review does not include these types of diseases. Individuals with Down syndrome residing in large institutional settings (long-term care facilities) have previously been reported to have less atherosclerotic plaque formation (atherosclerotic burden) than other age-matched persons with and without MR [Murdoch et al, 1977;Brattstrom et al, 1987;YlaHerttuala et al, 1989] and have subsequently have been labeled to be an "atheroma free" population [Murdoch et al, 1977]. Though the label, "atheroma free," may not be completely accurate, these autopsy findings have consistently demonstrated a very low prevalence of atherosclerosis in the coronary, aortic, carotid, femoral, iliac, and cerebral arteries for adults with Down syndrome residing in institutional settings [Murdoch et al, 1977;Brattstrom et al, 1987;YlaHerttuala et al, 1989].…”

“…Individuals with Down syndrome residing in large institutional settings (long-term care facilities) have previously been reported to have less atherosclerotic plaque formation (atherosclerotic burden) than other age-matched persons with and without MR [Murdoch et al, 1977;Brattstrom et al, 1987;YlaHerttuala et al, 1989] and have subsequently have been labeled to be an "atheroma free" population [Murdoch et al, 1977]. Though the label, "atheroma free," may not be completely accurate, these autopsy findings have consistently demonstrated a very low prevalence of atherosclerosis in the coronary, aortic, carotid, femoral, iliac, and cerebral arteries for adults with Down syndrome residing in institutional settings [Murdoch et al, 1977;Brattstrom et al, 1987;YlaHerttuala et al, 1989]. All of these previous studies, however, were performed on cadavers of individuals who previously resided in large congregate institutional settings where the behavioral risk factors for CVD, such as dietary intake and physical activity levels, were under direct supervision of health care professionals [Mercer and Eckvall, 1992;Golden and Hatcher, 1997] and the subjects' CVD risk profiles were not previously elevated [Murdoch et al, 1977;Brattstrom et al, 1987;Yla-Herttuala et al, 1989].…”