A cross-sectional study of non-invasive markers of vascular health in children and adolescents

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Abstract Background Non-invasive methods assessing subclinical atherosclerosis, such as carotid intima-media thickness (IMT) and carotid-femoral pulse wave velocity (cfPWV), are well-described in adults but less so in the paediatric population. Other techniques, such as aortic IMT, may be more appropriate in children. This study aimed to characterise age-related changes to arterial vasculature using best practice methodology for these measures. Methods This cross-sectional study involved 97 healthy volunteers aged 2 to 20 (mean age 11.2 years [SD 5.1]). Carotid and aortic IMT were measured using high-resolution ultrasound. A validated semi-automated cuff-based device was used to measure cfPWV. Results Aortic IMT showed a significant age-related increase of 9 μm per year [95% CI: 6, 12], p < 0.0001) during childhood and adolescence, whilst carotid IMT was significantly associated with male sex (29 μm per year [95% CI: 11, 48], p = 0.002) during this period. cfPWV exhibited an age-related increase from nine years of age onwards (0.11 ms -1 per year [95% CI: 0.06, 0.15], p < 0.001). Conclusions Age-related changes in the arterial vasculature vary between sites and methodologies. During childhood, aortic IMT appears to be a more sensitive marker for early structural changes and should be prioritised over carotid IMT and cfPWV. Impact Understanding age-related changes in arterial vasculature via non-invasive measures is poorly described in childhood and adolescence. This study finds that the timing and magnitude of age-related changes vary across arterial beds and between non-invasive measures in the first two decades of life. Aortic intima-media thickness is a more age-appropriate measure of early structural changes in the young than the more widely used carotid intima-media thickness. Furthermore, carotid-femoral pulse wave velocity, a measure of aortic stiffness, is best evaluated in late childhood and adolescence and likely has little relevance in early childhood.

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