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J Pediatr. 2019 Sep;212:79-86.e1. doi: 10.1016/j.jpeds.2019.04.059. Epub 2019 Jun 11.

Cross-Sectional Study of Arterial Stiffness in Adolescents with Down Syndrome.

Author information

1
Division of Endocrinology & Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine of University of Pennsylvania, Philadelphia, PA. Electronic address: kellya@chop.edu.
2
Children's National Health System, Children's Research Institute, The George Washington University School of Medicine and Health Sciences, Division of Endocrinology and Diabetes and CTSI-CN, Washington, DC.
3
Division of Endocrinology & Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA.
4
Department of Pediatrics, Perelman School of Medicine of University of Pennsylvania, Philadelphia, PA; Division of Developmental Behavioral Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA.
5
Department of Pediatrics, Perelman School of Medicine of University of Pennsylvania, Philadelphia, PA; Division of Gastroenterology, Hepatology, & Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA.
6
Department of Pediatrics, Perelman School of Medicine of University of Pennsylvania, Philadelphia, PA; Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA.
7
Familial Hypercholesterolemia Foundation, Pasadena, CA.
8
Department of Medicine, Perelman School of Medicine of University of Pennsylvania, Philadelphia, PA.

Abstract

OBJECTIVES:

To test whether youth with Down syndrome have aortic stiffness indices, as measured by pulse wave velocity (PWV), that differ from youth without Down syndrome and to compare reference-based age-adjusted (age-PWV-Z) and height-adjusted (Ht-PWV-Z) in youth with and without Down syndrome.

STUDY DESIGN:

Cross-sectional study of PWV in 129 adolescents with Down syndrome and 97 youth of comparable age, sex, race/ethnicity, and body mass index (BMI). PWV, age-PWV-Z, and Ht-PWV-Z were compared. Regression models were developed to test for associations with PWV.

RESULTS:

Youth with Down syndrome and controls were comparable in BMI-Z (1.4 [-1.5 to 2.8] vs 1.2 [-2.0 to 2.8], P = .57) but not Ht-Z (-2.3 [-4.7 to 0.8] vs 0.4 [-2.0 to 2.6], P < .0001). PWV (m/s, 5.0 [3.1-7.9] vs 5.0 [3.6-8.0], P = .5) and mean arterial pressure (MAP, mm Hg) (78 [61-102] vs 74 [64-97], P = .09) were not different between groups. In adjusted analyses confined to Down syndrome, PWV was associated only with BMI, but not age, black race, or MAP (R2 = 0.11). In contrast, BMI, age, black race, and MAP were all positively associated with and better explained PWV in controls (R2 = 0.50). PWV was not associated with height in youth with or without Down syndrome. Although age-PWV-Z was not different in Down syndrome (-0.36 [-2.93 to 3.49]) vs -0.15 [-2.32 to 3.22]), Ht-PWV-Z was greater in Down syndrome (0.32 [-2.28 to 4.07] vs -0.08 [-2.64 to 2.64], P = .002), and Ht-PWV-Z was greater than age-PWV-Z in Down syndrome (P < .0001).

CONCLUSIONS:

The lack of relationship of PWV, an independent predictor of adult cardiovascular events, with its traditional determinants including MAP suggests Down syndrome-specific phenomena may alter such relationships in this population. In youth with Down syndrome, Ht-adjusted PWV may overestimate aortic stiffness.

TRIAL REGISTRATION:

Clinicaltrials.gov: NCT01821300.

KEYWORDS:

Down syndrome; cardiovascular disease; obesity; pulse-wave velocity

PMID:
31201031
PMCID:
PMC6754250
[Available on 2020-09-01]
DOI:
10.1016/j.jpeds.2019.04.059

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