UCSF

Children with familial hypercholesterolemia (FH) and familial combined hyperlipidemia (FCH) are at risk for advanced atherosclerosis; however, they are often undiagnosed and undertreated. To examine the association among atherogenic lipids, inflammation, and endothelial dysfunction in children FH and FCH, a descriptive cross-sectional study was conducted. Dependent variables included endothelial function, as measured by brachial flow-mediated dilation, and inflammation, as measured by hsCRP. Independent variables included lipid profile and non-lipid variables. Lipid profile was measured by total cholesterol, triglycerides, LDL-C, HDL-C and nonHDL-C. Non-lipid predictors were measured by gender, age, BMI, blood pressure, and fasting blood glucose. Person Correlation Coefficients were calculated to evaluate the association between dependent variables and independent variables. Multiple linear regressions were modeled to identify predictors for endothelial function and inflammation.

Among 64 children with familial hyperlipidemia, the multiple regression models identified age as a significant independent variable for decreased brachial FMD. Increased fasting blood glucose and lower nonHDL-C were identified as significant independent variables for increased hsCRP. Age was a significant predictor, contributing 7% variance in brachial flow-mediated dilation (R² = 0.074, F = 4.978, p = 0.029). Beta coefficient indicated higher age was associated with higher brachial flow-mediated dilation. Individually, fasting blood glucose accounted for 14% variance and nonHDL-C accounted for 7% variance in hsCRP (R² = 0.232, F = 9.205, p = 0.000). Beta coefficients indicated lower fasting blood glucose and lower nonHDL-C were associated with higher LoghsCRP. Increased fasting blood sugar was associated with higher hsCRP and lower brachial flow-mediated dilation.

Although controversial to traditional findings, our data sheds a light on the complex impact of atherogenic lipids and inflammation on endothelial function in children. The important role of fasting sugar manifesting inflammation combined with the variability of total cholesterol, LDL-C and nonHDL-C in FH and FCH children aged 7 to 19 years old implicate a need for further investigation.