(Circulation. 1997;96:2233-2238.)
© 1997 American Heart Association, Inc.
Articles |
Flow-Mediated Dilation in 9- to 11-Year-Old Children
The Influence of Intrauterine and Childhood Factors
From the Vascular Physiology Unit (C.P.M.L., A.E.D., J.E.D.), Great Ormond Street Hospital; Department of Primary Care and Population Sciences (P.H.W., O.P.), Royal Free School of Medicine; Department of Public Health Sciences (D.G.C.), St George's Hospital Medical School; and MRC Childhood Nutrition Research Centre (C.P.M.L., A.L.), Institute of Child Health, London, England.
Correspondence to Dr P.H. Whincup, Cardiovascular Research Unit, Department of Primary Care and Population Sciences, Royal Free School of Medicine, Rowland Hill St, London, NW3 2PF UK.
Background Early life factors, particularly size at birth, may influence later risk of cardiovascular disease, but a mechanism for this influence has not been established. We have examined the relation between birth weight and endothelial function (a key event in atherosclerosis) in a population-based study of children, taking into account classic cardiovascular risk factors in childhood.
Methods and Results We studied 333 British children aged 9 to 11 years in whom information on birth weight, maternal factors, and risk factors (including blood pressure, lipid fractions, preload and postload glucose levels, smoking exposure, and socioeconomic status) was available. A noninvasive ultrasound technique was used to assess the ability of the brachial artery to dilate in response to increased blood flow (induced by forearm cuff occlusion and release), an endothelium-dependent response. Birth weight showed a significant, graded, positive association with flow-mediated dilation (0.027 mm/kg; 95% CI, 0.003 to 0.051 mm/kg; P=.02). Childhood cardiovascular risk factors (blood pressure, total and LDL cholesterol, and salivary cotinine level) showed no relation with flow-mediated dilation, but HDL cholesterol level was inversely related (-0.067 mm/mmol; 95% CI, -0.021 to -0.113 mm/mmol; P=.005). The relation between birth weight and flow-mediated dilation was not affected by adjustment for childhood body build, parity, cardiovascular risk factors, social class, or ethnicity.
Conclusions Low birth weight is associated with impaired endothelial function in childhood, a key early event in atherogenesis. Growth in utero may be associated with long-term changes in vascular function that are manifest by the first decade of life and that may influence the long-term risk of cardiovascular disease.
Key Words: endothelium • cardiovascular diseases • population • risk factors • atherosclerosis
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