Medición ecográfica del espesor medio-intimal carotídeo en pacientes pediátricos con obesidad, hipercolesterolemia familiar y diabetes tipo 1

Ultrasonography measurement of carotid intima-media thickness in pediatric patients with obesity, familial hypercholesterolemia and type 1 diabetes. Purpose. To evaluate by ultrasonographic images carotid intima-media thickness (IMT) as an early marker of cardio- vascular risk (CVR) in patients with clinical and laboratory diagnosis of familial hypercholesterolemia (FHC), type 1 diabetes (DBT-1) and Obesity (OB), compared to a healthy control group. Materials and Methods. A prospective, descriptive, and cross-sectional study. We evaluated the IMT of common carotid (cc) arteries and included in a single dichotomic vari- able other structural modifications of the wall (atheromatous plaques and intima irregularities). US was blinded to the blood tests results (as recommended by the 2007 Mannheim consensus) from 121 patients (aged 6 to 18 years): 24 FHC, 40 DBT-1, 43 OB, and 14 controls. Patients with other dis- eases that could alter the arterial wall were excluded. Variables were analyzed using the Statistix 8 program. Results. The three groups had a higher IMT than the con- trol group, with these differences being statistically signifi- cant. Mean IMT (mm) were 0.59 (0.31-2.15), p: 0.006, CI 0.06 to 0.36 in FHC; 0.48 (0.3-0.85), p: 0.001, CI 0.06-0.14 in obesity; and 0.46 (0.25-0.65), p: 0.0004, CI 0.03-0.13 in DBT-1. Control group: 0.37 (0.30-0.45). The major differ- ence was observed in FHC patients. No association was found between LDL-C value and IMT. Upon the examina- tion, 62.5% were receiving pharmacotherapy. In DBT-1 no association was found between IMT and the levels of HbA1c and lipids. In the OB group there was no association between IMT and BMI Z-score. Atheromatous plaques and intima irregularities were found in 31% of FHC patients, 8% of DBT-1 patients, and 6% of OB patients. Conclusion. Ultrasonographic IMT measurements demon- strated that patients with chronic diseases and increased CVR at adulthood presented early changes in the carotid intima-media at childhood. This allows clinical prevention strategies and therapeutic guidance. Keywords. Cardiovascular Risk. Children. Type 1 Diabetes. Familial Hypercholesterolemia. Intimal-Medial Thickness. Obesity. Ultrasound.