Long-term health consequences among individuals with SARS-CoV-2 infection compared to individuals without infection: results of the population-based cohort study CoMoLo Follow-up.

BACKGROUND: Most of the previous studies on health sequelae of COVID-19 are uncontrolled cohorts and include a relatively short follow-up. This population-based multi-center cohort study examined health consequences among individuals about 1 to 1.5 years after SARS-CoV-2 infection compared with non-infected. METHODS: The study population consisted of adults (≥ 18 years) from four municipalities particularly affected by the COVID-19 pandemic in the year 2020 who completed a detailed follow-up questionnaire on health-related topics. Exposure was the SARS-CoV-2 infection status (based on IgG antibodies, PCR test, or physician-diagnosis of COVID-19) at baseline (May to December 2020). Outcomes assessed at follow-up (October 2021 to January 2022; mean: 452 days) included recurrent or persistent health complaints, incident diseases, health-related quality of life (PROMIS-29), subjective health, and subjective memory impairment. Logistic and linear regression models were adjusted for baseline sociodemographic and lifestyle characteristics (age, sex, municipality, education, smoking, body mass index), pre-existing health conditions (chronic disease/health problem, health-related activity limitation, depressive/anxiety disorder), and follow-up time. RESULTS: Among 4817 participants, 350 had a SARS-CoV-2 infection at baseline and 4467 had no infection at baseline or during follow-up. Those with an infection statistically significantly more often reported 7 out of 18 recurrent or persistent health complaints at follow-up: smell/taste disorders (12.8% vs. 3.4%, OR 4.11), shortness of breath (23.0% vs. 9.5%, 3.46), pain when breathing (4.7% vs. 1.9%, 2.36), fatigue (36.9% vs. 26.1%, 1.76), weakness in legs (12.8% vs. 7.8%, 1.93), myalgia/joint pain (21.9% vs. 15.1%, 1.53) and cough (30.8% vs. 24.8%, 1.34) and 3 out of 6 groups of incident diseases: liver/kidney (2.7% vs. 0.9%, 3.70), lung (3.2% vs. 1.1%, 3.50) and cardiovascular/metabolic (6.5% vs. 4.0%, 1.68) diseases. Those with an infection were significantly more likely to report poor subjective health (19.3% vs. 13.0%, 1.91), memory impairment (25.7% vs. 14.3%, 2.27), and worse mean scores on fatigue and physical function domains of PROMIS-29 than non-infected. CONCLUSION: Even after more than one year, individuals with SARS-CoV-2 infection showed an increased risk of various health complaints, functional limitations, and worse subjective well-being, pointing toward profound health consequences of SARS-CoV-2 infection relevant for public health.

Carotid Intima-Media Thickness Percentiles in Adolescence and Young Adulthood and Their Association With Obesity and Hypertensive Blood Pressure in a Population Cohort.

BACKGROUND: This study aimed to derive carotid intima media thickness (CIMT) percentiles from a population-based sample of adolescents and young adults using improved technology, standardization and quality control, and to investigate the association of CIMT with hypertensive blood pressure (BP) and obesity. METHODS: Four thousand seven hundred nine 14- to 28-year-old participants of the German KiGGS cohort 11-year follow-up, which was based on a nationwide population sample, had B-mode ultrasound CIMT measurement with semi-automated edge-detection and automatic ECG-gated real-time quality control. CIMT percentiles were estimated from far wall CIMT during 2 to 6 heart cycles using the GAMLSS statistical model. Hypertensive BP, overweight, obesity, and a risk score from added Z scores of triglycerides, total/HDL (high-density lipoprotein)-cholesterol ratio, and glycated hemoglobin were based on standardized measurements at baseline and follow-up. RESULTS: CIMT differed by sex at all ages, furthermore by age and height in a nonlinear fashion. Percentiles were estimated simultaneously by age and height. Hypertensive BP and obesity were associated cross-sectionally and longitudinally with a higher risk of CIMT ≥75th percentile in log-binomial regression models adjusted for age, sex, height, current smoking, and cardiovascular risk score. For CIMT ≥90th percentile, the relative risk effect estimates were consistently >1 but often had large confidence intervals including 1, largest adjusted relative risk 3.37 (95% CI, 1.41-8.04) for the combination of hypertensive BP and obesity at follow-up. CONCLUSIONS: Based on state-of-the-art measurements and statistical techniques, these population-based CIMT percentiles by sex, age and height add unbiased evidence for the association of subclinical atherosclerosis with hypertensive BP and obesity in the young.

Rare Variation in Drug Metabolism and Long QT Genes and the Genetic Susceptibility to Acquired Long QT Syndrome.

BACKGROUND: Acquired long QT syndrome (aLQTS) is a serious unpredictable adverse drug reaction. Pharmacogenomic markers may predict risk. METHODS: Among 153 aLQTS patients (mean age 58 years [range, 14-88], 98.7% White, 85.6% symptomatic), computational methods identified proteins interacting most significantly with 216 QT-prolonging drugs. All cases underwent sequencing of 31 candidate genes arising from this analysis or associating with congenital LQTS. Variants were filtered using a minor allele frequency <1% and classified for susceptibility for aLQTS. Gene-burden analyses were then performed comparing the primary cohort to control exomes (n=452) and an independent replication aLQTS exome sequencing cohort. RESULTS: In 25.5% of cases, at least one rare variant was identified: 22.2% of cases carried a rare variant in a gene associated with congenital LQTS, and in 4% of cases that variant was known to be pathogenic or likely pathogenic for congenital LQTS; 7.8% cases carried a cytochrome-P450 (CYP) gene variant. Of 12 identified CYP variants, 11 (92%) were in an enzyme known to metabolize at least one culprit drug to which the subject had been exposed. Drug-drug interactions that affected culprit drug metabolism were found in 19% of cases. More than one congenital LQTS variant, CYP gene variant, or drug interaction was present in 7.8% of cases. Gene-burden analyses of the primary cohort compared to control exomes (n=452), and an independent replication aLQTS exome sequencing cohort (n=67) and drug-tolerant controls (n=148) demonstrated an increased burden of rare (minor allele frequency<0.01) variants in CYP genes but not LQTS genes. CONCLUSIONS: Rare susceptibility variants in CYP genes are emerging as potentially important pharmacogenomic risk markers for aLQTS and could form part of personalized medicine approaches in the future.

Blood pressure and resting heart rate in 3-17-year-olds in Germany in 2003-2006 and 2014-2017.

To track blood pressure (BP) and resting heart rate (RHR) in children and adolescents is important due to its associations with cardiovascular outcomes in the adulthood. Therefore, the aim of this study was to examine BP and RHR over a decade among children and adolescents living in Germany using national examination data. Cross-sectional data from 3- to 17-year-old national survey participants (KiGGS 2003-06, n = 14,701; KiGGS 2014-17, n = 3509) including standardized oscillometric BP and RHR were used for age- and sex-standardized analysis. Measurement protocols were identical with the exception of the cuff selection rule, which was accounted for in the analyses. Different BP and RHR trends were observed according to age-groups. In 3- to 6-year-olds adjusted mean SBP and DBP were significantly higher in 2014-2017 compared to 2003-2006 (+2.4 and +1.9 mm Hg, respectively), while RHR was statistically significantly lower by -3.8 bpm. No significant changes in BP or in RHR were observed in 7- to 10-year-olds over time. In 11- to 13-year-olds as well as in 14- to 17-year-olds lower BP has been observed (SBP -2.4 and -3.2 mm Hg, respectively, and DBP -1.8 and -1.7 mm Hg), while RHR was significantly higher (+2.7 and +3.7 bpm). BP trends did not parallel RHR trends. The downward BP trend in adolescents seemed to follow decreasing adult BP trends in middle and high-income countries. The increase in BP in younger children needs confirmation from other studies as well as further investigation. In school-aged children and adolescents, the increased RHR trend may indicate decreased physical fitness.

[Seroprevalence of SARS-CoV-2 among children and adolescents in Germany-an overview]. / SARS-CoV-2-Seroprävalenz bei Kindern und Jugendlichen in Deutschland ­ ein Überblick.

BACKGROUND: SARS-CoV­2 serologic studies complement and expand findings from confirmed COVID-19 cases through identification of undetected cases. OBJECTIVES: This article summarizes previous results on SARS-CoV­2 prevalence from seroepidemiological studies in Germany focusing on children and adolescents and complements the already existing overview on seroprevalence in adults from general population samples and especially blood donors in Germany. METHODS: The results are based on an ongoing systematic search in study registries, in literature databases, of preprint publications, and of media reports of seroepidemiological studies in Germany and their results. RESULTS: As of 17 September 2021, we are aware of 16 German seroepidemiological studies focusing on children and adolescents. Results are available for nine of these studies. For almost all settings studied, SARS-CoV­2 seroprevalence was well below 1% for preschool and elementary school children in the first COVID-19 wave and below 2% for adolescents. As the pandemic progressed, higher seroprevalences of up to 8% were found in elementary school children. DISCUSSION: Results of SARS-CoV­2 antibody studies in children and adolescents in Germany are scarce so far and are based on non-representative samples at local or regional level. In future studies, it is necessary on the one hand to estimate which proportion of children and adolescents has already either had an infection or has been vaccinated. On the other hand, it is important to investigate physical and mental health impairments that occur after an infection.

Utilisation of outpatient medical services in Germany - Results from GEDA 2019/2020-EHIS.

Outpatient health care provision plays an important role in the identification and treatment of health problems. Data are needed on the utilisation of health care services and their determinants to enable health policy decision-making and needs-based care provision. The analyses set out in this article are based on current data on the utilisation of outpatient health care services. The data stem from the German Health Update (GEDA 2019/2020-EHIS), a nationwide cross-sectional survey of the resident population in Germany that is undertaken as part of the health monitoring conducted at the Robert Koch Institute. Around 80% of the population aged 18 or over were treated at least once within twelve months by a general practitioner, 60% by a specialist, and 10% received psychiatric or psychotherapeutic treatment. Less than half of those eligible had had a stool test during the past two years, and just over half had had a colonoscopy in the past ten years. Around 80% of women and 70% of men had had their blood pressure checked within the last year, and 60% had had their blood cholesterol or blood sugar levels monitored. Over 50% reported that they had taken medically prescribed drugs in the past two weeks. In general, most of the indicators under study suggest that utilisation increases with age and that utilisation is higher among women than men, with the exception of psychiatric and psychotherapeutic services, among others.

Exercise and Carotid Properties in the Young-The KiGGS-2 Study.

Background: Carotid intima-media thickness (cIMT) and stiffness (cS) are predictive markers of early vascular aging and atherosclerotic risk. This study assessed, whether exercise has protective effects on carotid structure and function or on vascular risk in the young. Methods: Volume and change of exercise (recreational and organized sports participation) of German adolescents and young adults was assessed within the prospective population-study KiGGS at KiGGS-Wave-1 (2009-2012) and KiGGS-Wave-2 (2014-2017) using standardized self-reporting questionnaires. CIMT and cS were measured by real-time B-mode ultrasound sequences with semi-automated edge-detection and automatic electrocardiogram-gated quality control in 2,893 participants (14-28 years, 49.6% female). A cumulative index for atherosclerotic risk (CV-R) included z-scores of mean arterial pressure, triglycerides, total/HDL-cholesterol-ratio, body mass index, and HbA1c. Results: At KiGGS-Wave-2 cross-sectional CV-R but not cS and cIMT was lower in all exercise-groups compared to "no exercise" (B = -0.73, 95%-CI = -1.26 to 0.19, p = 0.008). Longitudinal volume of exercise was negatively associated with CV-R (B = -0.37, 95%-CI = -0.74 to 0.00, p = 0.048) but not with cS and cIMT. Cross-sectional relative risk of elevated CV-R but not cS and cIMT was lower in all exercise-groups compared to "no exercise" (RR = 0.80, 95%-CI = 0.66 to 0.98, p = 0.033). High exercise volumes were associated with lower relative risk of elevated CV-R (RR = 0.80, 95%-CI = 0.65-0.97, p = 0.021) and cS in tendency but not with cIMT. Conclusions: Increased levels of exercise are associated with a better cardiovascular risk profile in young individuals, but not with cS and cIMT. Our study confirms previous recommendations on exercise in this age group without demonstrating a clear benefit on surrogate markers of vascular health.

Carotid IMT and Stiffness in the KiGGS 2 National Survey: Third-Generation Measurement, Quality Algorithms and Determinants of Completeness.

Carotid intima-media thickness (cIMT) and carotid stiffness (CS) are important markers of atherosclerotic risk in the young. We assessed a novel third-generation method for its applicability in large population-based epidemiologic studies to determine strengths, limitations, completeness and predictors of unsuccessful measurement. Four thousand seven hundred ninety-eight 14- to 31-y-old participants of the German KiGGS cohort, which is based on a nationally representative sample with 11-y follow-up, underwent B-mode ultrasound examinations of the left and right common carotid artery with semi-automatic edge detection and automatic electrocardiogram-gated real-time quality control based on a sophisticated snake algorithm and subpixel interpolation. Overall completeness was 98% for far wall cIMT and 89% for CS parameters. Plane-specific completeness varied from 92%-96% for far wall and from 64%-69% for near-wall cIMT. Obesity independently predicted unsuccessful cIMT and CS measurements with odds ratios of 12.67 (95% confidence interval: 5.50-29.19) and 7.30 (4.87-10.94) compared with non-overweight after adjustment for blood pressure, cholesterol, smoking, hazardous drinking, age, sex and sonographer. Inter- and intra-rater reliabilities of cIMT and CS parameters in a sample of 15 young adults were good or excellent. Third-generation cIMT and CS measurements in the young with semi-automatic edge-detection and automatic real-time quality control has been successfully standardized with high reliability and very high completeness in a national survey setting. This provides a strong methodological foundation for further validation of the predictive value of cIMT and CS for atherosclerotic risk in the young.

[Erratum to: Application of medicines and nutritional supplements in childhood and adolescence in Germany]. / Erratum zu: Anwendung von Arznei- und Nahrungsergänzungsmitteln im Kindes- und Jugendalter in Deutschland.

In KiGGS Wave 2, data from 3­ to 17-year-olds were collected from a total of 3462 persons using a standardized interview on the current use of AM/NEM in the last seven days. For trends analysis, data from 14,679 study participants in the same age group from the KiGGS baseline study were used.In KiGGS Wave 2, 36.4% (95% CI 34.1-38.8) of the 3­ to 17-year-olds had used at least one AM/NEM in the last seven days. The prevalence was highest at 46.5% in 14- to 17-year-olds and significantly different between girls and boys (56.4% vs. 37.3%). Only among girls were there significant differences by migrant background with a higher prevalence of use among girls without a migrant background.Most frequently, the preparations used were for treatment of the respiratory tract (girls: 14.5%, boys: 15.1%), followed by "Varia" (girls: 8.7%, boys: 9.3%) and preparations for the treatment of the musculoskeletal system (girls: 9.0%, boys: 5.9%). There was a significant decrease in the overall prevalence of medicine use compared to the KiGGS baseline study (46.4% vs. 36.4%). This decrease was mainly due to lower prevalences of use in the ATC main groups "N Nervous System" (7.5% vs. 5.4%), "J Systemic Anti-infectives" (2.5% vs. 1.4%) and "H Systemic Hormones, excl. Sexual Hormones and Insulins" (2.0% vs. 1.1%).The results describe key points in the use of AM/NEM, including self-medication for children and adolescents in Germany. They illustrate the use behaviour and represent a valuable supplement to prescription data.

German and international studies on SARS-CoV-2 seroprevalence.

Since the beginning of the year 2020, the SARS-CoV-2 coronavirus has spread globally at a tremendous pace. Studies on the prevalence of SARS-CoV-2 antibodies in the population help estimate the number of people that have already been infected. They also allow an estimate of the number of undetected infections i.e. infections that do not appear in data on officially reported cases. The interpretation of study results needs to consider bias from selective sampling and the diagnostic test properties. To promote networking and co-operation between scientists, the Robert Koch Institute has compiled an overview of the seroepidemiological studies conducted in Germany on its website, which is regularly updated. The RKI conducts searches, for example of press releases, study registry entries or preprint server publications, and contacts the lead investigators of these studies. Of the 40 studies contacted so far, 24 have already provided information (as of 25.06.2020). We can differentiate between studies of the general population, of selected population groups such as healthcare workers, or of ongoing cohorts. This article provides an overview of such studies from Germany, but also of selected international studies. A special focus is set on studies of children and adolescents, which are now of particular interest due to the planned reopening of childcare facilities and schools.

Comparison of two blood pressure oscillometric devices: Datascope Accutorr Plus and Mobil-O-Graph PWA and conversion of blood pressure values from one device to the other.

OBJECTIVE: This study aims to compare two oscillometric devices used in national health surveys in Germany, Datascope Accutorr Plus and Mobil-O-Graph PWA and to develop formulas for the conversion of blood pressure (BP) values. METHODS: One hundred and four adults aged 21-86 years had nine alternate same-arm BP measurements according to the International Protocol revision 2010 for the validation of BP measuring devices in adults of the European Society of Hypertension. Measurements 2-8 yielded six pairs of measurements at 30- to 60-second interval with the two devices, totaling 743 pairs used for analysis. RESULTS: Mean Mobil-O-Graph SBP and DBP were higher than those from Datascope. Mean differences (Mobil-O-Graph minus Datascope) increased within BP ranges (optimal, normal, high normal, hypertensive stage 1, stage 2 and stage 3): SBP 0.5 ± 8.5, 3.1 ± 8.2, 3.7 ± 8.0, 5.3 ± 8.8, 13.8 ± 10.2 and 15.0 ± 25.9, respectively, and DBP 2.6 ± 5.6, 6.0 ± 4.9, 6.6 ± 5.2, 8.4 ± 4.8, 12.3 ± 4.6 and 20.4 ± 4.2, respectively. For Mobil-O-Graph pulse pressure less than 43 mm Hg, the DBP difference was 6.3 ± 5.5, and for Mobil-O-Graph pulse pressure more than 50 mm Hg, the SBP difference was 7.4 ± 9.3. The prevalence of BP at least 140/90 mm Hg was 28.8% with Mobil-O-Graph and 20.5% with Datascope. Bidirectional conversion models of SBP and DBP adjusting for BP, pulse pressure, sex, age and cuff width to arm circumference ratio were developed. CONCLUSION: The disagreement in oscillometric devices can reach a magnitude that can be relevant for clinical and epidemiological contexts. The here generated conversion formulas may help to improve comparability.

[Application of medicines and nutritional supplements in childhood and adolescence in Germany : Results from KiGGS Wave 2]. / Anwendung von Arznei- und Nahrungsergänzungsmitteln im Kindes- und Jugendalter in Deutschland : Ergebnisse aus KiGGS Welle 2.

In KiGGS Wave 2, data from 3­ to 17-year-olds were collected from a total of 3462 persons using a standardized interview on the current use of AM/NEM in the last seven days. For trends analysis, data from 14,679 study participants in the same age group from the KiGGS baseline study were used.In KiGGS Wave 2, 36.4% (95% CI 34.1-38.8) of the 3­ to 17-year-olds had used at least one AM/NEM in the last seven days. The prevalence was highest at 46.5% in 14- to 17-year-olds and significantly different between girls and boys (56.4% vs. 37.3%). Only among girls were there significant differences by migrant background with a higher prevalence of use among girls without a migrant background.Most frequently, the preparations used were for treatment of the respiratory tract (girls: 14.2%, boys: 14.9%), followed by "Varia" (girls: 8.7%, boys: 9.3%) and preparations for the treatment of the musculoskeletal system (girls: 8.9%, boys: 5.8%). There was a significant decrease in the overall prevalence of medicine use compared to the KiGGS baseline study (46.4% vs. 36.4%). This decrease was mainly due to lower prevalences of use in the ATC main groups "N Nervous System" (7.5% vs. 5.4%), "J Systemic Anti-infectives" (2.5% vs. 1.4%) and "H Systemic Hormones, excl. Sexual Hormones and Insulins" (2.0% vs. 1.1%).The results describe key points in the use of AM/NEM, including self-medication for children and adolescents in Germany. They illustrate the use behaviour and represent a valuable supplement to prescription data.

[Headache, abdominal and back pain in children and adolescents in Germany : Results from KiGGS Wave 2 and trends]. / Kopf­, Bauch- und Rückenschmerzen bei Kindern und Jugendlichen in Deutschland : Ergebnisse aus KiGGS Welle 2 und Trends.

BACKGROUND: Pain not only causes suffering in children and adolescents, but also leads to school absenteeism, medication intake, medical treatment, and an increased risk of recurrent pain in adulthood. OBJECTIVES: Based on data from the nationwide German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017), the 3­month prevalence of recurrent headache, abdominal and back pain in girls and boys is reported, and is compared with the prevalence from the KiGGS baseline survey (2003-2006). The consequences of recurrent headache were also explored. MATERIALS AND METHODS: Data from >11,000 participants (KiGGS Wave 2) and from >12,000 (KiGGS baseline) participants aged between 3 and 17 years were analyzed. For 3­ to 10-year-olds, parents/guardians answered the questions, while 11- to 17-year-olds provided information themselves. RESULTS: In 3­ to 10-year-olds, recurrent abdominal pain was most prevalent, affecting one third of girls and one quarter of boys. Headache was the most frequent type of pain in 11- to 17-year-olds, affecting almost every second girl and about every third boy. The 3­month prevalence of recurrent headache, abdominal and back pain has increased in girls and boys, especially in the age groups 7 to 10 years and 11 to 13 years. Among recurrent headache sufferers, adolescents take medication almost twice as often as children. CONCLUSIONS: Headache, abdominal, and back pain are still and with increasing prevalence very common symptoms in children and adolescents in Germany. Their prevention requires a holistic view of children's health in the psychosocial living environment, and healthcare context.

Selective Blood Pressure Screening in the Young: Quantification of Population Wide Underestimation of Elevated Blood Pressure.

Universal blood pressure (BP) screening in children and adolescents is questioned in prevention guidelines, while measuring blood pressure in the young in the context of overweight, obesity, or parental hypertension is promoted. This study quantifies with population data the underestimation of elevated blood pressure that would result from limiting BP screening only to those with overweight, obesity, or parental hypertension in the young. Selective screening was simulated with representative national health examination data from Germany (age 3-17, N=14,633, KiGGS0 study 2003-2006; age 18-39, N=1,884, DEGS1 2008-2011 study), with mean of two oscillometric measurements on one occasion; cutoffs for hypertensive BP in children were the 95th percentile using KiGGS percentiles, and for sensitivity analyses Fourth Report percentiles, in adults 140/90 mmHg; childhood overweight and obesity were classified according to the International Obesity Task Force and for adults as BMI ≥25 and ≥30 kg/m2. In 3-17-year-olds, different selective BP screening scenarios were simulated: screening only in those with obesity, overweight, parental hypertension, combination of overweight and parental hypertension, resulting in screening 5.6%, 20.0%, 28.5%, and 42.6% of the population and detecting 17.2%, 38.6%, 30.3%, and 58.2% of all hypertensive cases in the population. In conclusion our results show a large screening gap that would result from selective BP screening only in those with overweight, obesity, or parental hypertension.

[Secondary prevention of coronary heart disease in women and men in Germany from 1997-1999 and from 2008-2011-Trend analysis with two national health population surveys]. / Medikamentöse Sekundärprävention bei Frauen und Männern mit koronarer Herzkrankheit in Deutschland zwischen 1997­1999 und 2008­2011 ­ Trendanalyse mit Daten zweier bundesweiter Gesundheitssurveys.

BACKGROUND: The benefit of medicines in the secondary prevention of coronary heart disease (CHD) has been demonstrated in women and men. However, gender-specific differences have been observed in the prescription of these medicines. Information on trends in prevalence use in women and men from population-based studies are still lacking. METHODS: Data of people aged 40-79 years with CHD from the national health interview and examination surveys for adults in Germany from 1997-1999 (GNHIES98, n = 411) and from 2008-2011 (DEGS1, n = 440) were analyzed. Trend analyses via multivariable regression models, taking into account relevant covariables, were used to calculate the prevalence of medicine use in secondary prevention of CHD between GNHIES98 and DEGS1. The following groups were considered: antiplatelet, statins, beta-receptor blockers, agents acting on the renin-angiotensin system (RAS blocker), calcium-channel blockers, and nitrate. RESULTS: In one decade, the prevalence had increased for antiplatelet (24.0% vs. 59.6%), statins (18.5% vs. 56.2%), beta-receptor blockers (24.7% vs. 65.5%), and RAS blockers (31.6% vs. 69.0%). The prevalence of calcium-channel blockers (33.3% vs. 20.5%) and nitrate (40.6% vs. 10.1%) had decreased. In GNHIES98, men were more likely to use RAS blockers. Significant gender differences were found in DEGS1 only for angiotensin-converting-enzyme (ACE) inhibitors. CONCLUSION: This study showed an improvement in the use of drugs for the secondary prevention of CHD in both sexes.

Greater Susceptibility for Metabolic Syndrome in Pediatric Solid Organ and Stem Cell Transplant Recipients.

BACKGROUND: Cardiovascular comorbidity is of increasing importance after transplantation. Metabolic syndrome (MS) contributes to the risk for cardiovascular sequelae. Our aim was to assess the risk for MS in pediatric solid organ and stem cell transplant recipients by comparing them with matched untransplanted peers in a multicenter study. METHODS: We prospectively assessed MS in 295 pediatric transplant recipients and compared them with 1475 age- and sex-matched controls. RESULTS: Posttransplant metabolic syndrome (PTMS) was most frequent in lung (43%) and kidney (39%), followed by liver (16%) and stem cell (13%) recipients, compared with nontransplanted peers (4%; P < 0.01). The risk of displaying PTMS was almost 22-fold higher after lung (95% confidence interval, CI, 8.2-57.4), 16-fold higher after kidney (95% CI, 9.1-28.9), 5-fold higher after liver (95% CI, 2.1-10.1), and 4-fold higher after stem cell (95% CI, 1.4-9.5) transplantation. The contribution of individual components leading to MS differed depending on transplant type. In the combined analysis of all transplant groups, older age, less physical activity, calcineurin or mammalian target of rapamycin inhibitor-based immunosuppression, and hypovitaminosis D were associated with PTMS. CONCLUSIONS: By investigating a large group of patients, our study not only shows a high prevalence of PTMS but also identifies kidney and lung transplant patients as being at a particularly high risk. Moreover, knowledge on the factors associated with PTMS allows for individualized treatment approaches as well as potential preventive measures.