[Interrelationship between endothelial dysfunction, IMT of the carotid arteries and adhesion molecules in obese hypertensive children and adolescents].

INTRODUCTION: Adhesion molecules released by dysfunctional endothelial cells are markers of an early atherosclerotic process. Ultrasonography of the brachial arteries (flow mediated dilatation - FMD) is used to detect an impairment of endothelial vasodilation, whereas the examination of intima-media thickness complex (IMT) of the common carotid arteries detects the earliest structural changes of the vessels. The aim of the study was to define the correlations between biochemical markers of endothelial dysfunction (sICAM-1, sVCAM-1, sE-selectin), vasodilatatory function (FMD) and early atherosclerotic changes (IMT) in children and adolescents with obesity and hypertension.

MATERIAL AND METHODS: The study group consisted of 85 patients aged 14,6+/-2,4; of whom 22 obese children, 31 hypertensive children and 32 obese hypertensive children were distinguished. The control group included 26 healthy children. Adhesins concentrations were determined by an immunoenzymatic method (R&D Systems). FMD was assessed via the measurement of flow-mediated dilation of the brachial artery by ultrasound (Hewlett Packard Sonos 1000) according to the method worked out by Celermajer, whereas IMT was evaluated by means of Pignolie's method.

RESULTS: Linear correlation analysis proved a significant positive correlation between sICAM-1 and IMT (r=0,32, p=0,013) and a marked negative correlation between IMT and FMD (r=-0,26; p=0,04) in the whole study group. Analysis carried out in particular groups showed significant correlations only in the group of obese hypertensive children. sICAM-1 concentration correlated markedly positively with IMT (r=0,52; p=0,001) and negatively with FMD (r=-0,37; p=0,027). sE-selectin concentration correlated significantly positively with IMT (r=0,41; p=0,012). In regression models, IMT correlated with sICAM-1 (p=0,03) and BMI (p=0,02), whereas FMD correlated negatively with sICAM-1 (p=0,04).

CONCLUSIONS: The association between adhesion molecules (sICAM-1, sE-selectin) with impaired vasodilation activity and the early atherosclerotic structural changes in the common carotid arteries were found in obese hypertensive children and adolescents. The coexistence of both risk factors may predispose these young patients to closely related disturbances connected with early atherosclerosis.