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Normative values for intima–media thickness and distensibility of large arteries in healthy adolescents

Jourdan, Claudiaa,*,*; Wühl, Elkeb,*,*; Litwin, Mieczyslawc; Fahr, Katrinb; Trelewicz, Justynac; Jobs, Katarzynac; Schenk, Jens-Petera; Grenda, Ryszardc; Mehls, Ottob; Tröger, Jochena; Schaefer, Franzb

doi: 10.1097/01.hjh.0000178834.26353.d5
Original papers: Blood vessels

Objective Sonographic evaluation of arterial wall morphology and elasticity is increasingly accepted as a non-invasive tool in cardiovascular assessment. Several studies suggest that intima–media thickness (IMT) and arterial elasticity indices may sensitively reflect different vasculopathic processes in children. However, normative values and the impact of adolescent growth are largely unknown.

Methods We assessed the IMT of the common carotid (cIMT) and femoral arteries (fIMT), carotid elasticity indices and interacting anthropometric factors in 247 healthy subjects aged 10–20 years.

Results cIMT, fIMT, incremental elastic modulus (Einc) and circumferential wall stress (CWS) were positively, and distensibility coefficient (DC) inversely, correlated with age, height, body mass index (BMI), systolic blood pressure (BP) and brachial pulse pressure (r = 0.56 to −0.45, P < 0.05 to 0.0001). DC (r = −0.29, P < 0.0001) and stiffness index β (r = 0.25, P < 0.0001), but not Einc, were significantly associated with cIMT independently of age. All vascular parameters showed non-Gaussian distributions. Excessively high IMT was associated with BMI and pulse pressure above the 90th percentile, and elevated Einc with high-normal BMI. Multivariate analysis identified independent positive effects of standardized BMI and brachial pulse pressure on normalized cIMT, negative effects of systolic BP and cIMT on DC, a positive effect of cIMT on stiffness, and positive effects of systolic BP and BMI on Einc and CWS.

Conclusions Morphological and functional measures of large arteries should be normalized to take account of changes during adolescence and skewed distributions. Relative body mass, systolic blood pressure and/or pulse pressure are determinants of IMT and elasticity.

aDepartment of Pediatric Radiology

bDivision of Pediatric Nephrology, Children's Hospital, University of Heidelberg, Germany

cDepartment of Nephrology and Kidney Transplantation, The Children's Memorial Health Institute, Warsaw, Poland

**Both authors contributed equally to this work.

Received 27 August, 2004

Revised 29 April, 2005

Accepted 9 May, 2005

Sponsorship: Support for this study was obtained from the European Commission (5th Framework Programme, QLG1-CT-2002-00908) and Boehringer Ingelheim Stiftung.

Correspondence and requests for reprints to Dr Elke Wühl, University Children's Hospital, Im Neuenheimer Feld 153, 69120 Heidelberg, Germany. Tel: +49 6221 56 2396; fax: +49 6221 56 4203; e-mail: elke_wuehl@med.uni-heidelberg.de

© 2005 Lippincott Williams & Wilkins, Inc.