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Vascular health in children and adolescents: effects of obesity and diabetes
Vascular Health and Risk Management, 11/11/09

Short R et al. – Typically, cardiovascular screening is recommended for young adults, especially in people with a family history of cardiovascular conditions. Children and adolescents were once considered to be at low risk, but with the growing health concerns related to sedentary lifestyle, poor diet and obesity, cardiovascular screening may be needed earlier so that interventions to improve cardiovascular health can be initiated. This review describes comorbid conditions that increase cardiovascular risk in youth, namely obesity and diabetes, and describes noninvasive methods to objectively detect vascular disease and quantify vascular function and structure through measurements of endothelial function, arterial compliance, and intima–media thickness. Additionally, current strategies directed toward prevention of vascular disease in these populations, including exercise, dietary interventions and pharmacological therapy are described.

Exclusive Author Commentary
Kenneth C Copeland and Kevin Short, 11/13/09

Our recent comprehensive review of the literature has made it clear that we still have a lot yet to learn about the vascular complications of obesity and type 2 diabetes in children and adolescents. The problem of childhood obesity (and the attendant appearance of type 2 diabetes in children) is a recent phenomenon in the US, with rates increasing rapidly over the last 1-2 generations. Until recently it was uncommon to observe adult pathology in pediatric patients. The emerging picture, however, is that if we look closely enough, early signs of vascular pathology are present in obese children and precede anatomic changes. Furthermore, it is becoming clear that childhood obesity and vascular risk factors predict the occurrence of overt vascular abnormalities in early adulthood. Understanding what types of changes become evident in childhood and how to successfully intervene will be necessary to prevent or delay the onset of chronic disease in adulthood.