Prospective Study On Prediction Of Carotid Atherosclerosis In Adulthood Based On Obesity And Hypertension In Childhood

Background:With economic development, lives of the people level enhances unceasingly and cardiovascular disease will increase gradually. Cardiovascular disease is one of the most dangerous threats to human health. Atherosclerosis (AS) is one of the most threatening diseases to human health as well as the direct cause of the development of many cardiovascular diseases. At the same time, carotid atherosclerosis (CAS) increased socioeconomy burden.Comparison with study on cardiovascular risk factors, CAS was comparatively late. The development of the high-resolution B-mode ultrasound technique has provided a noninvasive way for the study of influence factors on CAS. In recent years, studies on cohort study are quite limited. The studies are not on all fours. At present there is a little literature about young people. Overall research on the influence factors of CAS could eliminate negative effect, which makes important sense to prevention and Control for CAS.Objective:To describe the distribution of CAS in the adult population aged 29-41 in Beijing and to study the impact factors of CAS in adulthood. To explore the role of childhood obesity, childhood blood pressure in predicting the risk of CAS.Methods:The population-based sample used of the 7th Five Years Programs for Science and Technology Development of China, "Beijing children and adolescents BP study cohort" (BBS).3198 people aged 6-18 were including in this research in 1987. A medical history was taken and physical examination was performed by a physician. Height, weight and blood pressure and other cardiovascular risk factors were measured. Longitudinal cohort data organized into C6, C9, C12, C15, C18 five queue data. The cohort data classification criterion is by age in the year of examination at baseline.1126 subjects were followed up and CAS risk factors and carotid ultrasound examinations were measured in 2010. To assess CAS in carotid artery bulb and common carotid artery thickness of carotid IMT,the numbers of plaque were calculated in different groups in the CAS.The age-and gender-specific BP reference standard of Chinese children and adolescents were used to define pre-hypertension and hypertension. Both SBP and DBP <90th percentile was defined as normal BP; SBP and/or DBP≥90th percentile and<95th percentile was defined as high normal; SBP and/or DBP≥95th percentile was defined as hypertension. In adulthood, hypertension was diagnosed according to the China Guideline for Hypertension Prevention and Control issued in 2010. Adult hypertension was diagnosed as SBP≥140 mmHg and/or DB≥90 mmHg or the subjects who were taking anti-hypertension drugs presently. Overweight and obesity in children and adolescents (7-18 years old) were defined according to the age-and gender-specific BMI reference values proposed by the Working Group on Obesity in China. We used the age-and gender-specific 85th and 95th BMI percentile from the Growth Charts proposed by US Center for Disease Control and Prevention in 2000 to define overweight and obesity in children aged 6 years old, respectively. In adults, overweight was defined as BMI>24 kg/m2 and BMI<28 kg/m2, and obesity was defined as BMI>28 kg/m2. Abdominal obesity of adult was defined as waist circumference (WC) for men≥90cm, female≥85cm; CAS was defined as cIMT thicker than normal or have patches. The normal values are cIMT<0.5mm in 20-29 age group, cIMT<0.6mm in 30--39 age group, cIMT< 0.7mm in 40-49 age group.Data from the questionnaires and laboratory tests were entered into EpiData 3.1. All data were analyzed using SPSS 18.0 and SAS9.1. The statistic methods used in this research including statistic descriptions, T-tests, Chi-squared tests, logistic regression, Pearson Correlation, multiple logistic stepwise regression analysis, path analysis and linear regression.Results:1. There was an interval of 23 years between the two researches. Baseline characteristics between the followed up population and the withsraw ones were similar in cardiovascular risk factors.2. Distribution of CAS indicators in adulthoodThis study detected 208 cases of CAS patients in adulthood, including 172 males (27.3%); and 36 females (7.3%).1) Thickness of cIMT:The average thickness of cIMT was 0.524cm in 29-41 years old adult were followed. There were detected 188 people (6.7%) cIMT thickness incrassation in total group, and in all age groups men's detection rate are higher than women. Left cIMT were thicker than the right, (P<0.001)2) Plaque:There were 38 people (3.4%) detected, including eight people were detected bilateral plaques, which 36 in male more than 2 in female(p<0.00l).Most of the plaques patients are males, over years 35. Plaques nature focused on Soft plaques, (41/ 46),23 in the left and 18 in the right.3) The changes of artery bore:In the age group of 30-34, there were a significant difference between males and females (P<0.05), but had no significant difference between other age groups. The male and female groups follow the same rules at different age groups:the smaller the age, the greater the change of artery bore, the smaller the age, the better the carotid elasticity.3. Influence factors on CAS in adulthood1) Univariate analysis:The factors were selected according to the professional knowledge and the references. After logistic regression analysis,13 factors of CAS including gender, age, education, smoking, alcohol, systemic obesity, abdominal obesity, blood pressure, TC,TG,HDL-C,LDL-C, diabetes, had a statistical significance at of 0.05.2) Multiple logistic stepwise regression analysis:13 meaningful factors were selected to, entering the final equation for the main factors affect CAS are:gender, age, smoking, general obesity, blood pressure and high LDL-C.3) Path analysis:As a risk factor, gender is the largest direct influencing factor of CAS, direct path coefficient is-0.250, witch female may be a protective factor for CAS. Followed by systemic obesity, age, direct path coefficients of CAS are 0.225 and 0.157, respectively. The role of smoking, blood pressure and high LDL-C on CAS also cannot be ignored, direct path coefficients are 0.122,0.101 and 0.087, respectively.4. Childhood obesity, childhood blood pressure in the role of risk forecasting in adulthood CAS1) relevance analysis between childhood BMI, childhood blood pressure and cIMT: At baseline, childhood BMI, childhood SBP linked to adulthood cIMT, With one unit change in BMI, cIMT in adulthood changed 0.158. Every change a unit in SBP, cIMT changed 0.163.2) Childhood obesity on the risk of adult CAS forecast:after adjusting for other risk factors, the ability of childhood obesity on the risk prediction CAS was 3.07 times than normal group,95%CI was 1.40～6.73. However, according to different age groups, only 9 and 12 age groups of childhood obesity group prediction on CAS had statistically significant, ORs (95%CIs) were 3.98 (1.33～11.89) and 3.50 (1.29～9.55) respectively.6, 15 and 18 age groups were not found the risk of CAS. Interaction analysis found that childhood obesity and adult obesity had the interaction effect on predict CAS in adulthood, P<0.05. When simple adulthood obesity, simple childhood obesity were used to diagnose adulthood CAS separately, compared with the normal group, ORs (95%CIs) were 2.88(1.77～4.71) and 3.49 (1.56～7.80), respectively. Both childhood and adulthood obesity group compared with the normal group, OR (95%CI) was 4.80 (2.74～8.42).2) Childhood blood pressure on the risk of adult CAS forecast:after adjusting for risk factors, childhood blood pressure on the risk prediction CAS was 2.51 times thant of normal group and the 95%CI was 1.54～4.07. However, only 15 age groups of childhood hyptension group prediction on CAS had statistically significant, OR (95%CI) was 2.17 (1.02～4.61).6,9,12 and 18 age groups were not found the risk of CAS. Interaction analysis found that when simple adulthood hypertension were used to diagnose adulthood CAS, compared with the normal group, there were no statistics significant. When simple childhood hypertension were used, OR (95%CI) was 2.03(1.21～3.42). Both childhood and adulthood hypertension group compared with the normal group, OR (95%CI) was 3.65 (2.24～5.97).Conclusions:1) Distribution of CAS indicators in adulthood:There were 27.3% of male and 7.3% of female detected CAS. The average thickness of cIMT was 0.524cm in 29～41 years old adult.16.7% of the total population detected cIMT incrassation, male was thicker than female and left>right.3.4% of the total population were detected plaques. Plaque type was concentrated in the soft plaque. The smaller the age, the better the carotid elasticity.2) Main factors directly affect CAS are gender, systemic obesity, age, smoking, blood pressure and high LDL-C. Education, alcohol, abdominal obesity, high TC, high TG, low HDL-C and diabetes has an indirect influence on CAS. The further investigation of blood lipid and diabetes is worthy to study.3) After adjusting for other influence factors, childhood obesity on the risk prediction CAS was 3.07 times that of normal group, childhood blood pressure on the risk prediction CAS was 2.51 times than normal group.