Non-Traditional Cardiovascular Risk Factors in Adolescents with Obesity and Metabolic Syndrome May Predict Future Cardiovascular Disease

Article

Non-Traditional Cardiovascular Risk Factors in Adolescents with Obesity and Metabolic Syndrome May Predict Future Cardiovascular Disease

Athanasia Tragomalou ^1,2, George Paltoglou ^1,2, Maria Manou ¹, Ioannis V. Kostopoulos ³, Sofia Loukopoulou ⁴, Maria Binou ¹, Ourania E. Tsitsilonis ³, Flora Bacopoulou ⁵, Penio Kassari ^1,2, Marina Papadopoulou ¹, George Mastorakos ⁶ and Evangelia Charmandari ^1,2,*

¹  Center for the Prevention and Management of Overweight and Obesity, Division of Clinical and Translational Research in Endocrinology, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, ‘Aghia Sophia’ Children’s Hospital, 11527 Athens, Greece

² Division of Endocrinology and Metabolism, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, 11527 Athens, Greece

³ Flow Cytometry Unit, Section of Animal and Human Physiology, Department of Biology, National and Kapodistrian University of Athens, 15784 Athens, Greece

⁴ Department of Pediatric Cardiology, ‘Aghia Sophia’ Children’s Hospital, 11527 Athens, Greece

⁵ Center for Adolescent Medicine in Adolescent Health Care, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, ‘Aghia Sophia’ Children’s Hospital, 11527 Athens, Greece

⁶ Division of Endocrinology, Diabetes Mellitus and Metabolism, Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens Medical School, ‘Aretaieion’ University Hospital, 11527 Athens, Greece

* Author to whom correspondence should be addressed.

Received: 23 August 2023 / Revised: 28 September 2023 / Accepted: 3 October 2023 / Published: 12 October 2023

Abstract

Obesity in adolescence is associated with significant morbidity and predisposes adolescents to the development of cardiovascular disease (CVD). Although a number of traditional CVD risk factors have been identified in youth, limited data exist regarding non-traditional CVD risk factors. In 89 adolescents with metabolic syndrome (MetS), with 60 age-, gender-, and BMI-matched controls, we determined the non-traditional CVD risk factors (hs-CRP, TG/HDL ratio, ApoB/ApoA1 ratio, NAFLD) in order to investigate whether they may be used as biomarkers for predicting future CVD, and we evaluated their response to the implementation of a multidisciplinary, personalized, lifestyle intervention program for 1 year. We demonstrated that the TG/HDL ratio, IL-2, IL-6, IL-17A, and INF-γ were significantly increased in subjects with MetS than in controls, and may be used as biomarkers to predict future CVD. Subjects with MetS had an increased mean carotid intima-media thickness (cIMT) and prevalence of NAFLD than the controls, while the prevalence of NAFLD correlated strongly with cIMT and IL-6 concentrations. Most of the non-traditional cardiovascular risk factors improved following the implementation of a lifestyle intervention program. These findings indicate that adolescents with MetS may have a greater risk for developing atherosclerosis early in life, while early lifestyle intervention is crucial for preventing the arteriosclerotic process in youth.

Keywords: obesity; cardiovascular disease; metabolic syndrome; atherosclerosis; cardiovascular risk factors; cytokines; carotid intima-media thickness