Kardiovaskuläres Risiko und chronische Entzündung

Zusammenfassung

Aus postmortalen Untersuchungen ist bekannt, dass die Bildung atherosklerotischer Gefäßwandläsionen ihren Ursprung bereits im Kindesalter findet und in enger Beziehung zu bekannten kardiovaskulären Risikofaktoren Erwachsener steht. Um mit Hilfe der Regenerationspotenziale im Kindes- und Jugendalter eine beschleunigte Entwicklung atherosklerotischer Gefäßveränderungen zu verhindern, bedarf es einer frühzeitigen Diagnose und konsequenten Behandlung kardiovaskulärer Risikofaktoren. Heranwachsende mit einer Autoimmunerkrankung, wie z. B. einer juvenilen idiopathischen Arthritis (JIA), besitzen aufgrund chronischer Entzündungszustände, medikamentöser Therapien und metabolischer Veränderungen ein erhöhtes kardiovaskuläres Risiko. Zur Exposition nicht traditioneller Risiken gesellen sich traditionelle, verhaltensbasierte Risikofaktoren, deren Vermeidung im Rahmen chronischer Erkrankungen besondere Bedeutung beigemessen wird. Der aktuelle wissenschaftliche Datenbestand bei JIA unterstreicht aus kardiovaskulärer Sicht die Notwendigkeit von Lebensstilmodifikationen, einschließlich insbesondere der Vermeidung eines bewegungsarmen, durch niedrigen energetischen Aufwand gekennzeichneten Alltags.

Abstract

Post-mortem studies have shown that the development of atherosclerotic vascular wall lesions originates in childhood and is closely related to known cardiovascular risk factors in adults. In order to prevent an accelerated development of atherosclerotic vascular changes with the help of regeneration potentials in childhood and adolescence, an early diagnosis and consistent treatment of cardiovascular risk factors are required. Adolescents with autoimmune disease, such as juvenile idiopathic arthritis (JIA), have an increased cardiovascular risk due to chronic inflammatory conditions, drug therapy and metabolic changes. The exposure to non-traditional risks is accompanied by traditional, behavioural risk factors, the avoidance of which is becoming increasingly important, especially in the context of chronic diseases. The current scientific database in JIA highlights the need for lifestyle modifications, including the avoidance of an everyday life characterized by low levels of physical activity and energy expenditure.

Schlüsselwörter

Kinder und Jugendliche - kardiovaskuläre Risikofaktoren - juvenile idiopathische Arthritis

Keywords

Children and adolescents - cardiovascular risk factors - juvenile idiopathic arthritis

• Literatur

• 1 Statistisches Bundesamt. Zahl der Todesfälle im Jahr 2015 um 6,5 % gestiegen. Zugriff am 12. Dezember 2018 unter https://www.destatis.de/DE/PresseService/Presse/Pressemitteilungen/2017/01/PD17_022_232pdf.pdf?__blob=publicationFile
• 2 Berenson GS, Srinivasan SR, Bao W. et al Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. N Engl J Med 1998; 338: 1650-1656
• 3 Zieske AW, Malcolm GT, Strong JP. Natural history and risk factors of atherosclerosis in children and youth: the PDAY study. Pediatr Pathol Mol Med 2002; 21: 213-237
• 4 Juonala M, Magnussen CG, Berenson GS. et al Childhood adiposity, adult adiposity, and cardiovascular risk factors. N Engl J Med 2011; 365: 1876-1885
• 5 Laitinen TT, Pahkala K, Magnussen CG. et al Ideal cardiovascular health in childhood and cardiometabolic outcomes in adulthood. The cardiovascular risk in young Finns study. Circulation 2012; 125: 1971-1978
• 6 Stabouli S, Kotsis V, Karagianni C. et al Blood pressure and carotid artery intima-media thickness in children and adolescents: the role of obesity. Hellenic J Cardiol 2012; 53: 41-47
• 7 Ezzati M, Lopez AD, Rodgers A. et al Selected major risk factors and global and regional burden of disease. Lancet 2002; 360: 1347-1360
• 8 Neuhauser HK, Thamm M, Ellert U. et al Blood pressure percentiles by age and height from nonoverweight children and adolescents in Germany. Pediatrics 2011; 127: e978-e988
• 9 Grundy SM. Primary prevention of coronary heart disease: integrating risk assessment with intervention. Circulation 1999; 100: 988-998
• 10 Lee IM. Physical activity and cardiac protection. Curr Sports Med Rep 2010; 9: 214-219
• 11 Brage S, Wedderkopp N, Ekelund U. et al Features of the metabolic syndrome are associated with objectively measured physical activity and fitness in Danish children: the European Youth Heart Study (EYHS). Diabetes Care 2004; 27: 2141-2148
• 12 Finger JD, Varnaccia G, Borrmann A. et al Körperliche Aktivität von Kindern und Jugendlichen in Deutschland – Querschnittergebnisse aus KiGGS Welle 2 und Trends. Journal of Health Monitoring 2018; 3: 24-31
• 13 Andersen LB, Harro M, Sardinha LB. et al Physical activity and clustered cardiovascular risk in children: a crosssectional study (The European youth heart study). The Lancet 2006; 368: 299-304
• 14 Lampert T, Sygusch R, Schlack R. Nutzung elektronischer Medien im Jugendalter. Ergebnisse des Kinder- und Jugendgesundheitssurveys (KiGGS). Bundesgesundheitsbl – Gesundheitsforsch – Gesundheitsschutz 2007; 50: 643-652
• 15 Mons U, Kahnert S. Neuberechnung der tabakattributablen Mortalität – Nationale und regionale Daten für Deutschland. Gesundheitswesen 2019; 81: 24-33
• 16 Zeiher J, Lange C, Starker A. et al Tabak- und Alkoholkonsum bei 11- bis 17-Jährigen in Deutschland – Querschnittergebnisse aus KiGGS Welle 2 und Trends. Journal of Health Monitoring 2018; 3: 23-44
• 17 West HW, Juonala M, Gall SL. et al Exposure to parental smoking in childhood is associated with increased risk of carotid atherosclerotic plaque in adulthood. The cardiovascular risk in young Finns study. Circulation 2015; 131: 1239-1246
• 18 Schwab KO, Doerfer J, Hallermann K. et al Marked smoking-associated increase of cardiovascular risk in childhood type 1 diabetes. Int J Adolesc Med Health 2008; 20: 285-292
• 19 Celermajer DS, Adams MR, Clarkson P. et al Passive smoking and impaired endothelium-dependent arterial dilatation in healthy young adults. N Eng J Med 1996; 334: 150-154
• 20 Kromeyer-Hauschild K, Moss A, Wabitsch M. Referenzwerte für den Body-Mass-Index für Kinder, Jugendliche und Erwachsene in Deutschland: Anpassung der AGA-BMI_Referenz im Altersbereich von 15 bis 18 Jahren. Adipositas 2015; 9: 123-127
• 21 Kromeyer-Hauschild K, Wabitsch M, Kunze D. et al Perzentile für den Body-Mass-Index für das Kindes- und Jugendalter unter Heranziehung verschiedener deutscher Stichproben. Monatsschrift Kinderheilkunde 2001; 149: 807-818
• 22 Schienkiewitz A, Brettschneider AK, Damerow S. et al Übergewicht und Adipositas im Kindes- und Jugendalter in Deutschland – Querschnittergebnisse aus KiGGS Welle 2 und Trends. Journal of Health Monitoring 2018; 3: 16-23
• 23 World Health Organization (WHO) Obesity and overweight. Zugriff am 20. Dezember 2018 unter http://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight
• 24 Larsson C, Hernell O, Lind T. Moderately elevated body mass index is associated with metabolic variables and cardiovascular risk factors in Swedish children. Acta Paediatr 2011; 100: 102-108
• 25 Wunsch R, Sousa G de, Toschke AM. et al Intima-media thickness in obese children before and after weight loss. Pediatrics 2006; 118: 2334-2340
• 26 Mokha JS, Srinivasan SR, Dasmahapatra P. et al Utility of waist-to-height ratio in assessing the status of central obesity and related cardiometabolic risk profile among normal weight and overweight/obese children: the Bogalusa Heart Study. BMC Pediatrics 2010; 10: 73
• 27 World Health Organization Global health risks: mortality and burden of disease attributable to selected major risks [Elektronische Version]. Geneva: World Health Organization; 2009
• 28 Scheidt-Nave Y, Du H, Knopf A. et al Verbreitung von Fettstoffwechselstörungen bei Erwachsenen in Deutschland. Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). Bundesgesundheitsblatt 2013; 56: 661-667
• 29 Raitakari OT, Juonala M, Kähönen M. et al Cardiovascular Risk Factors in Childhood and Carotid Artery Intima-Media Thickness in Adulthood: The Cardiovascular Risk in Young Finns Study. JAMA 2003; 290: 2277-2283
• 30 Lind M, Svensson AM, Kosiborod M. et al Glycemic control and excess mortality in type 1 diabetes. N Engl J Med 2014; 371: 1972-1982
• 31 Bertilsson L, Andersson-Gare B, Fasth A. et al Disease course, outcome, and predictors of outcome in apopulation-based juvenile chronic arthritis cohort followed for 17 years. J Rheumatol 2013; 40: 715-724
• 32 Selvaag AM, Aulie HA, Lilleby V. et al Disease progression into adulthood and predictors of long-term active disease in juvenile idiopathic arthritis. Ann Rheum Dis 2016; 75: 190-195
• 33 Raab A, Sengler C, Niewerth M. et al Comorbidity profiles among adult patients with juvenile idiopathic arthritis: results of a biologic register. Clin Exp Rheumatol 2013; 31: 796-802
• 34 Aulie HA, Selvaag AM, Gunther A. et al Arterial haemodynamics and coronary artery calcification in adult patients with juvenile idiopathic arthritis. Ann Rheum Dis 2015; 74: 1515-1521
• 35 Butbul AY, Stremler R, Benseler SM. et al Sleep and fatigue and the relationship to pain, disease activity and quality of life in juvenile idiopathic arthritis and juvenile dermatomyositis. Rheumatology 2011; 50: 2051-2060
• 36 Takken T, Hemel A, van der Net J. et al Aerobic fitness in children with juvenile idiopathic arthritis: a systematic review. J Rheumatol 2002; 29: 2643-2647
• 37 Norgaard M, Twilt M, Andersen LB. et al Accelerometry-based monitoring of daily physical activity in children with juvenile idiopathic arthritis. Scand J Rheumatol 2016; 45: 179-187
• 38 Klepper SE, Darbee J, Effgen SK. et al Physical fitness levels in children with polyarticular juvenile rheumatoid arthritis. Arthritis care and research: the official J Arthritis Health Professions Association. 1992; 5 (02) 93-100
• 39 Lelieveld OT, Armbrust W, van Leeuwen MA. et al Physical activity in adolescents with juvenile idiopathic arthritis. Arthritis Rheum 2008; 59: 1379-1384
• 40 Bos GJ, Lelieveld OT, Armbrust W. et al Physical activity in children with Juvenile Idiopathic Arthritis compared to controls. Pediatr Rheumatol Online J 2016; 14: 42
• 41 Gueddari S, Amine B, Rostom S. et al Physical activity, functional ability, and disease activity in children and adolescents with juvenile idiopathic arthritis. Clin Rheumatol 2014; 33: 1289-1294
• 42 Long AR, Rouster-Stevens KA. The role of exercise therapy in the management of juvenile idiopathic arthritis. Curr Opin Rheumatol 2010; 22: 213-217
• 43 Klepper SE. Exercise in pediatric rheumatic diseases. Curr Opin Rheumatol 2008; 20: 619-624
• 44 Bohr A, Nielsen S, Müller K. et al Reduced physical activity in children and adolescents with juvenile idiopathic arthritis despite satisfactory control of inflammation. Pediatr Rheumatol 2015; 13: 57
• 45 Van Pelt PA, Takken T, van Brussel M. et al Aerobic capacity and disease activity in children, adolescents and young adults with juvenile idiopathic arthritis (JIA). Pediatr Rheumatol 2012; 10: 27
• 46 Grönlund MM, Kaartoaho M, Putto-Laurila A. et al Juvenile idiopathic arthritis patients with low inflammatory activity have increased adiposity. Scand J Rheumatol 2014; 43: 488-492
• 47 Caetano MC, Sarni RO, Terreri MT. et al Excess of adiposity in female children and adolescents with juvenile idiopathic arthritis. Clin Rheumatol 2012; 31: 967-971
• 48 Surís J, Michaud P, Akre C. et al Health risk behaviors in adolescents with chronic conditions. Pediatrics 2008; 122: e1113-e1118
• 49 Nash AA, Britto MT, Lovell DJ. et al Substance use among adolescents with juvenile rheumatoid arthritis. Arthritis Care Res 1998; 11: 3916
• 50 Listing M, Liedmann I, Niewerth M. Health behavior in adolescents with juvenile idiopathic arthritis- results of the inception cohort of newly diagnosed patients (ICON). Ann Rheum Dis 2017; 76 (Suppl. 02) 76.1-76
• 51 Tam CS, Clement K, Baur LA. et al Obesity and low-grade inflammation: a paediatric perspective. Obes reviews : an official J Int Assoc Stud Obes 2010; 11 (02) 118-126
• 52 Pelajo CF, Lopez-Benitez JM, Miller LC. Obesity and disease activity in juvenile idiopathic arthritis. Pediatr Rheumatol online J 2012; 10 (01) 3
• 53 Schenck S, Niewerth M, Sengler C. et al Prevalence of overweight in children and adolescents with juvenile idiopathic arthritis. Scand J Rheumatol 2015; 44: 288-295
• 54 Amine B, Ibn YY, Rostom S. et al Prevalence of overweight among Moroccan children and adolescents with juvenile idiopathic arthritis. Joint Bone Spine 2011; 78 (06) 584-586
• 55 Glowinska-Olszewska B, Bossowski A, Dobrenko E. et al Subclinical Cardiovascular System Changes in Obese Patients with Juvenile Idiopathic Arthritis. Mediaters of Inflammation 2013; 2013: 436702
• 56 Caetano MC, Sarni ROS, Terreri MTL. et al Excess of adiposity in female children and adolescents with juvenile idiopathic arthritis. Clin Rheumatol 2012; 31: 967-971
• 57 Samad A, Stoll ML, Lavi I. et al Adiposity in Juvenile Psoriatic Arthritis. J Rheumatol 2018; 45: 411-418
• 58 Ilowite NT, Samuel P, Beseler L. et al Dyslipoproteinemia in juvenile rheumatoid arthritis. J Pediatr 1989; 114: 823-826
• 59 Tselepis AD, Elisaf M, Besis S. et al Association of the inflammatory state in active juvenile rheumatoid arthritis with hypo-high-density lipoproteinemia and reduced lipoprotein-associated platelet-activating factor acetylhydrolase activity. Arthritis Rheum 1999; 42: 373-383
• 60 Goncalves M, D’Almeida V, Guerra-Shinohara EM. et al Homocysteine and lipid profile in children with Juvenile Idiopathic Arthritis. Pediatr Rheumatol Online J 2007; 5: 2
• 61 Bakkaloglu A, Kirel B, Ozen S. et al Plasma lipids and lipoproteins in juvenile chronic arthritis. Clin Rheumatol 1996; 15: 341-345
• 62 Marangoni RG, Hayata AL, Borba EF. et al Decreased high-density lipoprotein cholesterol levels in polyarticular juvenile idiopathic arthritis. Clinics (Sao Paulo) 2011; 66: 1549-1552
• 63 Breda L, Di Marzio D, Giannini C. et al Relationship between inflammatory markers, oxidant-antioxidant status and intima-media thickness in prepubertal children with juvenile idiopathic arthritis. Clin Res Cardiol 2013; 102: 63-71
• 64 Schenck S, Rosenbauer J, Niewerth M. et al Comorbidity of Type 1 Diabetes Mellitus in Patients with Juvenile Idiopathic Arthritis. J Pediatr 2018; 192: 196-203
• 65 Prahalad S, O’Brien E, Fraser AM. et al Familial aggregation of juvenile idiopathic arthritis. Arthritis Rheum 2004; 50: 4022-4027
• 66 Pohjankoski H, Kautiainen H, Kotaniemi K. et al Autoimmune diseases in children with juvenile idiopathic arthritis. Scand J Rheumatol 2010; 39: 435-436
• 67 Bharti BB, Kumar S, Kapoor A. et al Assessment of left ventricular systolic and diastolic function in juvenile rheumatoid arthritis. J Postgrad Med 2004; 50: 262-267
• 68 Oguz D, Ocal B, Ertan U. et al Left ventricular diastolic functions in juvenile rheumatoid arthritis. Pediatr Cardiol 2000; 21: 374-377
• 69 Alkady EA, Helmy HA, Mohamed-Hussein AA. Assessment of cardiac and pulmonary function in children with juvenile idiopathic arthritis. Rheumatol Int 2012; 32: 39-46