Risk factor clustering detects cardiovascular disease in youth

Risk factor clustering is a simple, reliable tool that clinicians can use to detect cardiovascular (CV) disease in youth, according to a study published online in Pediatrics.

As part of a cross-sectional study of the vascular effects of obesity in youth, researchers compared vascular thickness and stiffness in 474 adolescents and young adults classified into low- and high-risk groups based on the number of CV risk factors present at evaluation.

Participants ranged from 11 to 23 years old (mean, 18 years) and had no evidence of type 2 diabetes. Cardiovascular risk factors assessed included body mass index, blood pressure, metabolic derangement (ie, elevated fasting glucose or fasting insulin), and dyslipidemia. General linear models were used to compare clustering CV risks with the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) score, a measure that is not routinely used in clinical practice.

Compared with participants in the low-risk group (0-1 CV risk factors), those in the high-risk group (2-4 CV risk factors) had significantly greater vascular thickness and stiffness as determined by carotid ultrasound studies. In addition, researchers found that clustering CV risk factors into low- and high-risk groups is associated with abnormal vascular structure and function, after adjustment for age, race, and gender.

The modified PDAY score also was associated with abnormal vascular structure and function, “suggesting that clustering of cardiovascular risks is a reliable tool for assessing abnormal vascular function,” the researchers write. Because CV risk clustering is simpler to use than the PDAY score, they conclude that this provides a tool for the clinician to identify youth who are at higher risk for early CV disease. They recommend that multiple risk factor assessment should be an integral part of care for youth as it is for adults.

Shah AS, Dolan LM, Gao Z, Kimball TR, Urbina EM. Clustering of risk factors: a simple method of detecting cardiovascular disease in youth. Pediatrics. 2011;127(2):e312-e318.