Comparison of carotid intima-media thickness in pediatric patients with metabolic syndrome, heterozygous familial hyperlipidemia and normals.

Background. Our goal was to compare the carotid intimal-medial thickness (CIMT) of untreated pediatric patients with metabolic syndrome (MS), heterozygous familial hyperlipidemia (heFH), and MS+heFH against one another and against a control group consisting of healthy, normal body habitus children. Methods. Our population consisted of untreated pediatric patients (ages 5-20 yrs) who had CIMT measured in a standardized manner. Results. Our population included 57 with MS, 23 with heFH, and 10 with MS+heFH. The control group consisted of 84 children of the same age range. Mean CIMT for the MS group was 469.8 µ m (SD = 67), 443.8 µ m (SD = 61) for the heFH group, 478.3 µ m (SD = 70) for the MS+heFH group, and 423.2 µ m (SD = 45) for the normal control group. Significance differences between groups occurred for heFH versus MS (P = 0.022), heFH versus control (P = 0.038), MS versus control (P = 9.0E - 10), and MS+heFH versus control (P = 0.003). Analysis showed significant negative correlation between HDL and CIMT (r = -0.32, P = 0.03) but not for LDL, triglycerides, BP, waist circumference, or BMI. Conclusion. For pediatric patients, the thickest CIMT occurred for patients with MS alone or for those with MS+heFH. This indicates that MS, rather than just elevated LDL, accounts for more rapid thickening of CIMT in this population.

Assessment of metformin as an additional treatment to therapeutic lifestyle changes in pediatric patients with metabolic syndrome.

Objective. To assess the effectiveness of metformin and therapeutic lifestyle changes (TLCs) in a clinical setting, compared to TLC alone in adolescents with metabolic syndrome (MS). Methodology. This study was a retrospective trial consisting of 60 patients, aged 8-18 years, who were treated for MS at an outpatient clinic. Two groups were formed: the metformin group (M group) and the control group (C group). The M group had been given metformin along with TLC, and the C group had been given TLC alone. Several outcome measures were obtained; the main outcome measure was measuring the change in percentile and z-score of weight and BMI. Results. There were no significant differences between the two groups at the conclusion of the study, except for height percentile (P = 0.02) and z-score (P = 0.03). Both groups showed promising significant intragroup decreases in weight z-score but BMI percentile and z-score were only significantly decreased in the M group. Conclusion. Metformin at an average dose of 1033 mg, when added to TLC, did not show any clinically important efficacy compared to TLC alone in a pediatric population with MS. However, both groups made significant changes in a positive direction, which may be solely due to TLC.

A pilot study in the efficacy and safety of gemfibrozil in a pediatric population.

BACKGROUND: Gemfibrozil reduces plasma triglycerides and raises high-density lipoprotein cholesterol (HDL-C) in adults and also reduces the incidence of cardiovascular endpoints in adults. Its efficacy in improving lipid abnormalities has not been evaluated in children. OBJECTIVE: Our purpose was to investigate whether gemfibrozil would lower triglycerides and raise HDL-C with minimal adverse effects in a pediatric population with metabolic syndrome. METHODS: We conducted a retrospective study of 47 pediatric patients with metabolic syndrome who started gemfibrozil treatment, 1200 mg/day because of failure or lack of interest in therapeutic lifestyle changes. Eligibility required patients to be younger than 21 years of age, and have pretreatment and on-treatment fasting lipid profiles. Data recorded included age at start of treatment, blood pressure, body mass index, waist circumference, percent body fat, total plasma cholesterol, HDL, low-density lipoprotein, triglycerides, alanine aminotransferase, and aspartate aminotransferase. Treatment duration was elapsed time between starting gemfibrozil and the last clinic visit. RESULTS: Average age of the study cohort was 14 years and mean duration on medication was 249 days. Those patients who had pretreatment and on-treatment plasma lipid data (33 of 47) were included in an analysis for efficacy. All 47 patients were monitored for safety. Mean triglycerides decreased by 57%: 426 (standard error of mean = 33.6) to 184 mg/dL (standard error of mean = 19) (P < 0.0001). Mean HDL increased by 20%: 35 to 42 mg/dL (P < 0.001). Body composition changes were insignificant, indicating that the lipid changes can be attributed to gemfibrozil. Two of forty-seven patients reported muscle pain from the drug, one of whom was considered to have had a possible adverse effect from the medication as indicated by muscle pain. CONCLUSION: Gemfibrozil significantly lowers triglycerides and raises HDL with reasonable safety in a pediatric population with metabolic syndrome.

Threshold of trichloroethylene contamination in maternal drinking waters affecting fetal heart development in the rat.

Halogenated hydrocarbons such as trichloroethylene (TCE) are among the most common water supply contaminants in the United States and abroad. Epidemiologic studies have found an association but not a cause-and-effect relation between halogenated hydrocarbon contamination and increased incidence of congenital cardiac malformations or other defective birth outcomes. Avian and rat studies demonstrated statistically significant increases in the number of congenital cardiac malformations in those treated with high doses of TCE, either via intrauterine pump or in maternal drinking water, compared with controls. This study attempts to determine if there is a threshold dose exposure to TCE above which the developing heart is more likely to be affected. Sprague-Dawley rats were randomly placed in test groups and exposed to various concentrations of TCE (2.5 ppb, 250 ppb, 1.5 ppm, 1,100 ppm) in drinking water or distilled water (control group) throughout pregnancy. The percentage of abnormal hearts in the treated groups ranged from 0 to 10.48%, with controls having 2.1% abnormal hearts, and the number of litters with fetuses with abnormal hearts ranged from 0 to 66.7%, and the control percentage was 16.4%. The data from this study indicate not only that there is a statistically significant probability overall of a dose response to increasing levels of TCE exposure, but also that this trend begins to manifest at relatively low levels of exposure (i.e., < 250 ppb). Maternal rats exposed to more than this level of TCE during pregnancy showed an associated increased incidence of cardiac malformations in their developing rat fetuses.

Acute cardiac effects of nicotine in healthy young adults.

BACKGROUND: Nicotine is known to have many physiologic effects. The influence of nicotine delivered in chewing gum upon cardiac hemodynamics and conduction has not been well-characterized. METHODS: We studied the effects of nicotine in nonsmoking adults (6 male, 5 female; ages 23-36 years) using a double-blind, randomized, cross-over study. Subjects chewed nicotine gum (4 mg) or placebo. After 20 minutes (approximate time to peak nicotine levels), echocardiograms and signal-averaged electrocardiograms (SAECG) were obtained. After 40 minutes, subjects were again given nicotine gum or placebo in cross-over fashion. Standard echocardiographic measurements were made from two-dimensional images. We then calculated end-systolic wall stress (ESWS), shortening fraction (SF), systemic vascular resistance (SVR), velocity for circumferential fiber shortening corrected for heart rate (Vcfc), stroke volume, and cardiac output. P wave and QRS duration were measured from SAECG. RESULTS: Significant differences (P < 0.05) from control or placebo were found for ESWS, mean blood pressure, cardiac output, SVR, heart rate, and P wave duration. No significant changes were seen in left ventricular ejection time (LVET), LV dimensions, SF, contractility (Vcfc), or QRS duration. CONCLUSIONS: These results suggest that nicotine chewing gum increases afterload and cardiac output. Cardiac contractility does not change acutely in response to nicotine gum. Heart rate and P wave duration are increased by chewing nicotine gum.

Alcohol- and Caffeine-Induced Changes in Mitral Valve Echo Morphology and Auscultation in Healthy Females.

Mitral valve prolapse (MVP) is a common cardiac valve abnormality that affects women more frequently than men. We have shown that mild dehydration induces echocardiographic signs of MVP in healthy females more frequently than in males. The present study investigated whether ethanol and caffeine, two commonly used substances, will induce changes in mitral leaflet morphology in normal subjects and whether these changes are gender dependent. Ten healthy volunteers were examined after ingesting 0.95 g/kg ethanol at breath ethanol values of 0.025% +/- 0.005%, 0.050% +/- 0.005%, and 0.075% (peak) +/- 0.005%, and at decreasing ethanol levels of 0.050% +/- 0.005% and 0.025% +/- 0.005%. Twelve healthy subjects were studied at 1.5, 3, and 4.5 hours after ingesting 5 mg/kg body weight of caffeine in a randomized, double-blind, crossover manner. A significant increase in mitral valve shape index (MVSI) on apical four-chamber view was documented in females following ethanol ingestion at all ethanol levels. These changes were accompanied by auscultatory findings characteristic of MVP. Decreased systemic vascular resistance, and afterload and increased heart rate, also occurred after ethanol ingestion. A significant increase in MVSI occurred on parasternal long axis in females at peak caffeine level; auscultatory findings characteristic of MVP also were documented. MVSI increased slightly on apical four-chamber view in males; however, no male subject developed auscultatory MVP. Body mass index was significantly lower in females (20.8 +/- 0.7 kg/m(2)) versus males (23.7 +/- 0.3 kg/m(2), P < 0.05). All subjects lost weight after caffeine intake; afterload and contractility also were increased. This study documents that ethanol and caffeine, at concentrations similar to those present in social intake, induced significant echo changes in mitral leaflet morphology and auscultation suggestive of MVP in healthy females. These results suggest that in addition to apparent hydration state, recent ethanol or caffeine intake should be taken into consideration before making the diagnosis of MVP.

Accuracy of two-dimensional echocardiography for measuring right ventricular outflow tract in tetralogy of falott

As medidas ecocardiográficas do trato de saída do ventrículo direito de 21 pacientes com tetralogia de Fallot, com idades entre 1 dia e 15 anos, realizadas em fim de sístole e diástole foram comparadas com as medidas correspondentes obtidas pela angiografia biplana. As medidas ecocardiográficas subestimaram às angiográficas em aproximadamente 10%. Houve melhor correlaçäo entre as dimensöes ecocardiográficas e angiográficas nos pacientes submetidos a correçäo cirúrgica, provavelmente em virtude das maiores dimensöes da via de saída do ventrículo direito e, conseqüentemente, melhor resoluçäo e maior facilidade na realizaçäo das medidas neste grupo de pacientes. Aplicada de maneira prospectiva a ecocardiografia bidimensional pode ser de utilidade no manuseio clínico destes pacientes, bem como no planejamento do momento oportuno para realizaçäo do cateterismo cardíaco