CVD Risk in Pediatric Weight Loss Surgery Patients

Internal Medicine World Report, March 2015,

Cardiovascular risks are increased proportionally among pediatric patients with increasing obese body mass indexes, according to research from JAMA Pediatrics.

Various cardiovascular disease (CVD) risks are present for adolescents undergoing weight loss surgery, according to results published in JAMA Pediatrics.

A multifaceted team of researchers examined 242 patients aged 19 years or younger who underwent weight loss surgeries at 5 adolescent weight loss surgery centers in the US between February 2007 and December 2011 to determine the baseline prevalence and predictors of CVD among this population.

The patients were considered at risk for CVD if they displayed the following characteristics: having dyslipidemia, abnormally high low density lipoprotein (LDL) cholesterol or triglyceride (TG) levels, abnormally low high density lipoprotein (HDL) cholesterol levels, or were taking medications for dyslipidemia. The researchers hypothesized that even in a severely obese young study population, the higher body mass index (BMI) levels would be linked to having greater CVD risk factors.

The researchers found the median BMI for the patients was 50.5. The patients had a myriad of CVD risk factors, such as:

- Fasting hyperinsulinemia (74%)

- Elevated high sensitivity C reactive protein levels (75%)

- Dyslipidemia (50%)

- Elevated blood pressure (49%)

- Impaired fasting glucose (IFG) levels (26%)

- Diabetes mellitus (14%)

For every 5 unit increase in BMI, the risk of impaired glucose levels, elevated blood pressure, and elevated high sensitivity C reactive protein levels increased by 15, 10, and 6% respectively, the researchers determined. Additionally, dyslipidemia and elevated blood pressure were more commonly found in adolescent boys compared with adolescent girls. Elevated TG levels were more commonly found in white participants, though the same population was less likely to have IFG levels.

The researchers also divided the study population into 3 groups based on their BMI: group 1 (BMI < 50), group 2 (BMI, ≥50-<60), and group 3 (BMI ≥ 60). The prevalence of IFG varied significantly among the lowest BMI group than the 2 higher categories, at a rate of 18, 31, and 38%, respectively.

“Despite the fact that all participants were already severely obese, we were nonetheless able to detect a graded risk for elevated blood pressure and IFG across categories of BMI in this cohort,” the authors concluded. “Although such overt manifestations of CVD are rarely present in the pediatric population, associated clinical and biological risk factors have been identified during childhood and adolescence and these CVD risk factors are known to track into adulthood.”

The investigators wrote that reversing severe obesity could be important in preventing future CVD in this population.