Modifiable cardiovascular risk factors in adolescents and adults with congenital heart disease

Harris, Kevin C.; Voss, Christine; Rankin, Kathryn N.; Aminzadah, Basmina; Gardner, Ross F.; Mackie, Andrew S.

doi:10.1111/chd.12612

Cited by 24 publications

(20 citation statements)

References 45 publications

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“…Moons et al reported that almost 80% of patients with congenital heart disease had at least one cardiovascular risk factor, despite a young age of the patients (median age: 26 years) . Additionally, Harris et al reported that only approximately 30% of adolescents and adults with congenital heart disease were in ideal cardiovascular health …”

Section: Discussionmentioning

confidence: 99%

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Cardiovascular risk factors in adults with coarctation of the aorta

Fedchenko

Mandalenakis

Dellborg

et al. 2019

Congenital Heart Disease

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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.

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Section: Discussionmentioning

confidence: 99%

“…Patients with congenital heart disease have been reported to have a high prevalence of cardiovascular risk factors, with almost 80% of patients having at least one cardiovascular risk factor . Decreased glucose tolerance on oral glucose tolerance test (OGTT) is more common in patients with complex ACHD compared with healthy controls .…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular risk factors in adults with coarctation of the aorta

Fedchenko

Mandalenakis

Dellborg

et al. 2019

Congenital Heart Disease

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“…The prevalence of obesity has been steadily increasing over the past decades [8] and the trend is similar in patients with CHD (9,10,15). Recent studies using the American dataset [9] and the Canadian CHD registry [17] found no difference in overweight and obesity rates between CHD and non-CHD paediatric populations. In a recent cohort study, the rates of metabolic syndrome were similar between adults with CHD and healthy control subjects [18].…”

Section: Proportion Of Underweight Overweight and Obesity Over Timementioning

confidence: 99%

Congental Heart Disease: Growth Evaluation and Sport Activity in a Paediatric Population

Zoller¹,

Prioli²,

Clemente³

et al. 2021

Preprint

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Objective: To understand the anthropometric changes in paediatric patients with CHD, to evaluate their status and to assess their sport activity frequency.Methods: Of 535 children on follow up, we selected 368 Caucasian children (aged 2-18 years) with CHD, had at least one visit with measured weight and height, with no comorbidities that could influence growth. A total of 1690 complete anthropometric measurements were analyzed. Anthropometric z-scores were computed using formulae based on the LMS method according to Cacciari growth standards.Underweight, overweight and obesity were defined using BMI percentile cut-offs. Sport activity was collected through a phone interview.The CHD severity was classified as mild, moderate, severe, univentricular or unclassified.Results: Significant increase with age was observed for weight z-score [beta (95%CI): 0.03 (0.02,0.05) for one-unit of age] and BMI z-score [0.06 (0.03,0.08)] but not for height z-score. The percentage of underweight increased with disease severity, and the percentages of overweight and obese patients consequently decreased. The percentage of obesity in patients with mild CHD (5.9% [95%CI: 3.4,8.4]) was not significantly different from that in patients with moderate CHD (3.3% [1.5,5.0]), whereas it was lower in patients with severe CHD (0.4% [0.0,0.9]). No obese patients with univentricular heart defect was observed. Days spent in sport activities was equal to 1.9 [95%CI: 1.6,2.2] days/week, 1.9 [1.5,2.2], 1.4 [1.1,1.7] and 0.7 [0.1,1.3] in patients with mild, moderate, severe and univentricular CHD, respectively.Conclusions: Children with mild and moderate CHD present a risk of becoming overweight or obese that could not be underestimated and on the other hand could be prevented or reduced promoting an healthy lifestyle.

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“…Physical activity is known to decrease adiposity and BMI, and markers of stress and chronic inflammation, and to mitigate the association between stress and adiposity in otherwise healthy children [51][52][53][54]. Physical activity has similar health benefits in children with CHD [16,40,[55][56][57]; thus early stress experienced by children with CHD may underlie findings of elevated waist circumference, and weaker associations between physical activity and waist circumference. The theory is compelling that there exists a cascade whereby early physical and psychological stress leads to elevated inflammation and cortisol, which drives elevated abdominal fat accrual, further contributing to inflammation and vascular alteration, which cannot be fully offset by physical activity, and ultimately leading to increased cardiovascular disease risk.…”

Section: A Mechanistic Link Between Waist Circumference and Cardiovasmentioning

confidence: 99%

A cardiovascular disease risk factor in children with congenital heart disease: unmasking elevated waist circumference - a CHAMPS* study *CHAMPS: Children’s Healthy-Heart Activity Monitoring Program in Saskatchewan

Barbour-Tuck

Boyes

Tomczak

et al. 2020

BMC Cardiovasc Disord

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Background: Children with congenital heart disease (CHD) have an elevated risk of future cardiovascular disease but the underlying mechanisms are unclear. Abdominal obesity (measured as waist circumference) is a risk factor for adult onset of cardiovascular diseases and is correlated with low physical activity levels, commonly found in children with congenital heart disease. Elevated waist circumference may be a mechanism by which cardiovascular disease risk is elevated in children with CHD. The purpose of this study was to compare waist circumference between children with and without CHD, while considering potential confounders. We hypothesized that children with CHD would have higher measures of waist circumference when controlling for differences in birthweight, lean mass, and physical activity. Methods: Thirty-two children with CHD (10.9 ± 2.6 years; 12 female) from the Children's Healthy-Heart Activity Monitoring Program in Saskatchewan, and 23 healthy controls (11.7 ± 2.5 years; 10 female) were studied. Waist circumference, physical activity (physical activity questionnaire), body composition (lean mass; dual x-ray absorptiometry), and birthweight were assessed. Analysis of covariance, Mann-Whitney U, and independent sample t-tests were used to assess group differences (p < 0.05). Results: Children with CHD had greater waist circumference than controls, controlling for lean mass, physical activity, birthweight, and sex (F (1, 49) = 4.488, p = 0.039). Physical activity, lean mass, and birthweight were not significantly different between groups (p > 0.05). Conclusion: Our findings generate a novel hypothesis-higher waist circumferences in children with CHD compared to age-matched controls, may contribute to an elevated risk of cardiovascular disease.

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Modifiable cardiovascular risk factors in adolescents and adults with congenital heart disease

Abstract: A low proportion of individuals with CHD are in ideal cardiovascular health, suggesting a need to promote healthy lifestyles during adolescence and throughout adulthood in these individuals.

Cited by 24 publications

References 45 publications

Cardiovascular risk factors in adults with coarctation of the aorta

Cardiovascular risk factors in adults with coarctation of the aorta

Congental Heart Disease: Growth Evaluation and Sport Activity in a Paediatric Population

A cardiovascular disease risk factor in children with congenital heart disease: unmasking elevated waist circumference - a CHAMPS* study *CHAMPS: Children’s Healthy-Heart Activity Monitoring Program in Saskatchewan

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