Prevalence of Atherogenic Index and Its Relationship to Abdominal Obesity, Hypertension and Insulin Resitance in Obese Pediatric Patients of South Bronx
Cardiovascular disease (CVD) is the leading cause of mortality in the USA. The process begins in pediatrics. As the prevalence of childhood obesity is increasing, more and more pediatric patients are at risk for early atherogenesis and metabolic dysfunction. There is a well-established correlation between high LDL-C , low HDL-C and CVD. Studies have shown that the ratio of TG to HDL-C (Atherogenic Index- AI) is a strong predictor of CVD in adults, however the data from pediatric studies is lacking.
Objective: To evaluate the prevalence of abnormal AI in overweight and obese pediatric patients in a community hospital of South Bronx and its correlation with BMI, waist circumference (WC), Insulin Resistance Index (IRI), pre hypertension and hypertension in this population.
In this cross-sectional study, data were collected from EMR of overweight and obese pediatric patients for age, sex, ethnicity, BMI, WC, blood pressure, fasting glucose, insulin and lipid profile. BMI was calculated using standard formula. HOMA-IR formula: [fasting glucose (mmol/l) x fasting insulin (mU/L)]/22.5 and AI formula: log [TG(mg/dl)/HDL-C(mg/dl), low risk AI (<0.11), high risk AI (>0.21). Mc Nemar's t-test and Pearson's correlation test were used for statistical analysis.
The mean age for 82 males was 13 ± 2 and 65 females was 14 ± 3 years. Mean BMI was 33.3 ±6.5 (32.6 ± 5.9 males, 34.3± 7 females). Adverse AI was found in 82% of patients (85% males, 80% females). Males had 8 times higher odds of having AI as compared to females (p<0.0001). Prehypertension was present in 13% (7% males, 20% females (BP: 90-95th percentile) and Hypertension in 23% (20% males, 26% females (BP: >95thpercentile). Prevalence of metabolic syndrome (WHO criteria) was 26% (22% males, 30% females). Males with high risk AI had 13 times and females 34 times higher odds of having hypertension as compared to those with low risk AI (p<0.0001). 100% (12/12) males and 94% (17/18) females with adverse IRI had adverse AI. There was a linear correlation of adverse AI with WC.
Atherogenic index is a simple and great tool in assessing the risk of CAD. High risk atherogenic index is associated with abdominal obesity, hypertension and insulin resistance in pediatric obese patients. Further prospective studies are required to evaluate the progression of CVD in patients with high risk atherogenic index.