Atherogenesis in youth – Early consequence of adolescent smoking
Introduction
Despite all efforts to reduce smoking in young adults on a global scale cigarette smoking remains a prevalent risk behavior in adolescents [1]. Smoking in youth tracks into adulthood and early nicotine addiction reduces the chances of smoking cessation in adulthood. In view of the high relevance of smoking for cardiovascular diseases later in life, the early uptake of this habit is a concern. Atherosclerosis, the key cause of cardiovascular diseases, originates in childhood. The association between cardiovascular risk factors in childhood, such as obesity, diabetes or hyperlipidemia, and atherosclerotic disease in adulthood has been shown convincingly in cohort studies [2], [3], and, remarkably, have been associated with arterial changes already in childhood [4], [5], [6], [7], [8], [9]. Active as well as passive smoking has been associated with an increase of inflammation, oxidative stress, platelet activation, and endothelial dysfunction [10] – all potential mechanisms in the development of atherosclerosis. Postmortem studies found arterial wall pathologies in infancy and adolescence [11], [12] and first evidenced an atherogenic effect of tobacco smoke in youth [13]. Other studies have addressed the impact of parental smoking on arterial changes in childhood [14], [15], [16], [17], [18], [19]. To our knowledge, the association of active smoking with CIMT in adolescence has not been well investigated.
The SAPALDIA Youth Study collected and measured classical cardiovascular risk factors and CIMT along with the SAPALDIA adult cohort study in 2010 and 2011. The present study investigated the impact of active smoking exposure on early atherogenesis in youth.
Section snippets
Methods
The SAPALDIA Youth Study is a cross-sectional study nested into the Swiss Study on Air Pollution And Lung and Heart Disease In Adults (SAPALDIA) [20], a cohort recruited and assessed in 1991 and followed up twice since, in 2001 and 2010/11. In the second follow-up, the four Swiss-German speaking centers participated in the SAPALDIA Youth Study. Offspring of adult SAPALDIA participants born between the first and second survey (N = 530) were asked to participate in the study. If more than one
Results
The mean age of the study sample was 15 years (interquartile range 12–18 years); 53% youth were female. The lifetime prevalence of smoking was 32%. Ten percent reported smoking at least once a week and additional four percent smoked at least once a month. Weekly smokers were older (mean age 18 yrs) and reported higher puberty levels than non-smoking younger participants (Table 1). A quarter of the offspring reported current parental smoking (24%), but less than half of the parents smoked
Discussion
Despite the young age of our study population and consequently a short smoking history we observed thicker carotid artery walls among currently smoking adolescents. These results were robust in different models using various measures of smoking and adjusting for parental confounders, most importantly parental smoking and cardiovascular risk factors. To our knowledge this study is the first to investigate active smoking and CIMT in a healthy adolescent population.
Smoking in adolescence continues
References (45)
- et al.
Association of pathobiologic determinants of atherosclerosis in youth risk score and 15-year change in risk score with carotid artery intima-media thickness in young adults (from the Cardiovascular Risk in Young Finns Study)
Am J Cardiol
(2007) - et al.
Carotid artery stiffness in obese children with the metabolic syndrome
Am J Cardiol
(2006) - et al.
Smoking and atherosclerosis in youth
Atherosclerosis
(1999) - et al.
Sex differences of carotid intima-media thickness in healthy children and adolescents
Atherosclerosis
(2009) - et al.
Cardiovascular risk factors and non-invasive assessment of subclinical atherosclerosis in youth
Atherosclerosis
(2010) - et al.
Obese related effects of inflammatory markers and insulin resistance on increased carotid intima media thickness in pre-pubertal children
Atherosclerosis
(2008) - et al.
Relative contributions of adiposity in childhood and adulthood to  vascular health of young adults
Atherosclerosis
(2013) - et al.
A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010
Lancet
(2012) - et al.
- et al.
Childhood cardiovascular risk factors and carotid vascular changes in adulthood: the Bogalusa Heart Study
J Am Med Assoc
(2003)
Obese children show increased intimal wall thickness and decreased pulse wave velocity
Clin Physiol Funct Imaging
Body fat distribution and early arterial changes in healthy 5-year-old children
Ann Med
Elevated serum c-reactive protein levels and early arterial changes in healthy children
Arterioscler Thromb Vasc Biol
Endothelial dysfunction and increased arterial intima-media thickness in children with type 1 diabetes
Circulation
Intima-Media thickness in obese children before and after weight loss
Pediatrics
Cardiovascular effects of secondhand smoke: nearly as large as smoking
Circulation
Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study
N Engl J Med
Origin of atherosclerosis in childhood and adolescence
Am J Clin Nutr
Tobacco smoke exposure is associated with attenuated endothelial function in 11-year-old healthy children
Circulation
Cardiovascular risk factors and atherosclerosis in young males: ARMY study (atherosclerosis risk-factors in male youngsters)
Circulation
Parental smoking and vascular damage in young adult offspring: is early life exposure critical?: the atherosclerosis risk in young adults study
Arterioscler Thromb Vasc Biol
Arterial intima-media thickness, endothelial function, and apolipoproteins in adolescents frequently exposed to tobacco smoke
Circ Cardiovasc Qual Outcomes
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Lifestyle, inadequate environments in childhood and their effects on adult cardiovascular health
2022, Jornal de PediatriaCitation Excerpt :Apparently, there are different impacts of tobacco use of children and adolescents on the cardiovascular risk of adults. In the situation of active smoking, there is a strong association with cIMT and CV events, such as AMI and stroke; in scondhand smoking, there is an association with cIMT and the presence of atherosclerotic plaque.35 Although there is a less evidence of a direct and independent association between childhood habits and cardiovascular risk in adults, the relationship among lifestyle, CVRF and their late consequences is well established.
Infectious diseases are associated with carotid intima media thickness in adolescence
2015, AtherosclerosisCitation Excerpt :Childhood infectious disease score: all reported childhood infections were given the value 1 and were added up to a continuous exposure variable (min 0 – max 9), as well as a categorical variable (none, one, two, three infectious or more diseases reported). Trained SAPALDIA field workers examined the youth at the study centers following standard operating procedures described in detail elsewhere [36]. In short, anthropometric measurements (height, weight and waist hip ratio) were taken with the child dressed in light clothing without shoes; non-fasting blood samples were drawn for analyses of cardio-metabolic (glucose, HbA1c, total cholesterol, HDL-cholesterol) and inflammatory biomarkers (hsCRP), systolic and diastolic blood pressure was measured twice with an oscillograph after sitting quietly for at least 10 min.
Intima media thickness measurement in children: A statement from the Association for European Paediatric Cardiology (AEPC) Working Group on Cardiovascular Prevention endorsed by the Association for European Paediatric Cardiology
2015, AtherosclerosisCitation Excerpt :Especially in older children, where the cIMT is not homogeneously distributed among the region of interest, this may lead to significant over- or underestimation of the cIMT with the consequence that small differences in cIMT would result in a wrong classification of the individual patient. Newer cIMT parameters include “average”- cIMT as a result from several end-diastolic and end-systolic measurements during at least 3 heart cycles [21]. In case off line software is used ideally the cIMT value should be calculated from three separate video-loops from each common carotid artery and reported as mean cIMT separately for the right and left common carotid artery, as the values for the different vessels may differ [14].
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