Electrocardiogram (ECG) is a common non-invasive diagnostic tool for cardiovascular diseases. Adequate data is crucial in utilizing deep learning to achieve intelligent diagnosis of ECG. The existing ECG datasets almost only focus on adults and most of them do not provide cardiovascular disease diagnosis. In this study, we propose an ECG database with cardiovascular disease diagnosis for children aged 0-14 years old. This dataset is acquired from 11643 hospitalized children at the First Affiliated Hospital of Zhengzhou University from 2018 to 2024, including 14190 pediatric ECG records, of which 12334 were 12 lead and 1856 were 9 lead. The sampling rate is 500 Hz and the record length is 5-120 seconds. We followed the recommendations of AHA/ACC/HRS and the diagnostic statements in the consensus of Chinese ECG experts to encode and convert all ECG records. In this dataset, 3516 ECG records were diagnosed with cardiovascular diseases, and these labels were derived from 19 common diseases in the pediatric cardiovascular field, including myocarditis, cardiomyopathy, congenital heart disease, and Kawasaki disease.

Post-cancer therapy kidney outcomes, including chronic kidney disease (CKD) and hypertension, are common in childhood cancer survivors (CCS). The incidence and timing of CKD and hypertension in CCS compared with other at-risk or general populations are unclear.

To determine the association of childhood cancer treatment with post-cancer therapy CKD or hypertension.

Population-based matched cohort study of children treated for cancer between April 1993 and March 2020 in Ontario, Canada, with follow-up until March 2021. The CCS (exposed) cohort included children (≤18 years) surviving cancer. Comparator cohorts were a hospitalization cohort (children who were hospitalized) and a general pediatric population (GP) cohort (all other Ontario children). Exclusion criteria were history of previous cancer, organ transplant, CKD, dialysis, or hypertension. Matching with each of the 2 comparator cohorts was performed separately and in a 1:4 ratio by age, sex, rural vs urban status, income quintile, index year, and presence of previous hospitalization. Data were analyzed from March 2021 to August 2024.

Treatment for cancer.

The primary outcome was the composite of CKD or hypertension, defined by administrative health care diagnosis and procedure codes. Fine and Gray subdistribution hazard modeling, accounting for competing risks (death and new cancer diagnosis or relapse) and adjusting for cardiac disease, liver disease, and diabetes, was used to determine the association of cancer treatment with outcomes.

There were 10 182 CCS (median [IQR] age at diagnosis, 7 [3-13] years; 5529 male [54.3%]; median [IQR] follow-up time, 8 [2-15] years) matched to 40 728 hospitalization cohort patients (median [IQR] age at diagnosis, 7 [2-12] years; 5529 male [weighted percentage, 54.3%]; median [IQR] follow-up time, 11 [6-18] years) and 8849 CCS (median [IQR] age at diagnosis, 5 [2-11] years; 4825 male [54.5%]; median [IQR] follow-up time, 7 [2-14] years) matched to 35 307 GP cohort individuals (median [IQR] age at diagnosis, 6 [2-11] years; 4825 male [weighted percentage, 54.5%]; median [IQR] follow-up time, 10 [5-16] years). Most frequent cancer types were leukemia (2948 patients [29.0%]), central nervous system neoplasms (2123 patients [20.9%]), and lymphoma (1583 patients [15.5%]). During observation, cumulative incidence of CKD or hypertension was 20.85% (95% CI, 18.75%-23.02%) in the CCS cohort vs 16.47% (95% CI, 15.21%-17.77%) in the hospitalization cohort and 19.24% (95% CI, 15.99%-22.73%) in the CCS cohort vs 8.05% (95% CI, 6.76%-9.49%) in the GP cohort. CCS were at increased risk of CKD or hypertension compared with the hospitalization cohort (adjusted hazard ratio, 2.00; 95% CI, 1.86-2.14; P < .001) and the GP cohort (adjusted hazard ratio, 4.71; 95% CI, 4.27-5.19; P < .001).

In this population-based study, CCS were at increased risk for CKD and hypertension, which are associated with mortality, suggesting that early detection and treatment of these conditions in CCS may decrease late complications and mortality.

Elevated blood pressure (BP) during childhood and adolescence is increasingly being recognized as a precursor to adult hypertension and cardiovascular disease (CVD). This review examines the existing evidence of the relationship between early BP elevations and long-term cardiovascular (CV) outcomes. Previous studies demonstrated a moderate association between childhood BP and adult hypertension, with early BP elevations contributing to subclinical CV changes such as left ventricular hypertrophy and increased carotid intima-media thickness as well as major premature CVD events in adulthood. However, evidence also indicates that BP normalization before adulthood may mitigate these risks, suggesting a critical interventional window before irreversible CV changes occur. Multiple modifiable and nonmodifiable factors contribute to early-life BP elevations, including genetic predisposition, a high sodium intake, obesity, sedentary behavior, and sleep disturbances. Although establishing a direct causal association between childhood BP and adult hypertension or CVD remains challenging owing to the need for longterm follow-up and large sample sizes, further research is essential to addressing the existing knowledge gaps in pediatric hypertension prevention, detection, impact, and treatment. This review highlights the importance of preventing BP elevations early in life to reduce the longterm burden of hypertension and CVD. Promoting healthy behaviors, such as maintaining a healthy weight, reducing one's sodium intake, engaging in physical activity, and ensuring adequate sleep, is essential for managing BP at an early age. These efforts reduce individual CV risk and help alleviate the broader future public health burden of hypertension and CVD.

Hypertension has shown a trend of prevalence at younger ages, and the non-dipping pattern is associated with target organ damage in hypertension. However, few studies have yet investigated the clinical characteristics and risk factors of non-dipper status in essential hypertension children. This study aimed to explore the clinical characteristics and possible indicators associated with non-dipper status in children with essential hypertension.

A total of 125 children (99 boys, 26 girls) with untreated essential hypertension were retrospectively included in this study. Non-dipping was defined as a nocturnal drop in systolic or diastolic BP (SBP, DBP) < 10%. Clinical data, ambulatory blood pressure monitoring (ABPM), laboratory and echocardiography parameters were recorded from the hospital database.

Non-dipping pattern was found in 74 (59.2%) children and the dipping pattern in 51(40.8%) children, and the nocturnal SBP drop was 8.43 ± 0.71 (%), and the DBP drop was 14.44 ± 0.86 (%). The proportion of children with left ventricular hypertrophy was higher in the non-dipping group than in the dipping group. The platelet distribution width, high-sensitivity C-reactive protein (hs-CRP) and triglycerides (TG) levels were higher in the non-dipping group compared with the dipping group. In multivariate logistic regression analysis, PDW, TG and hs-CRP were found to be associated with the non-dipping pattern.

Non-dipping pattern in children hypertension is common, and the proportion of left ventricular hypertrophy is higher in non-dipping hypertension children. Moreover, higher PDW, hs-CRP and TG levels are the risk factors for non-dipping status in essential hypertension children.

Pediatric hypertension (HTN) is a significant, growing health concern worldwide and also in Korea. Diagnosis, evaluation, and treatment of HTN in Korean children and adolescents are uncertain due to limitations in using the current international guidelines, since the recommendations by the American Academy of Pediatrics (AAP) and European Society of Hypertension (ESH) guidelines differ. Furthermore, these are guidelines for Western youth, who are racially and ethnically different from Koreans. In addition, reference blood pressure values for all pediatric age groups, which are essential for the diagnosis of HTN according to these two guidelines, are absent in Korea. Therefore, HTN guidelines for Korean children and adolescents should be established. The Korean Working Group of Pediatric Hypertension established clinical guidelines for the diagnosis, evaluation, and management of HTN in Korean children and adolescents. These guidelines were based on reported clinical evidence, expert recommendations, and AAP and ESH guidelines. The characteristics of Korean youth and the Korean medical and insurance system were considered during the establishment of the guidelines. By providing recommendations suitable for Korean youth, these guidelines will help in the prevention and management of childhood HTN, thus relieving the burden of cardiovascular disease in adulthood in Korea.

Despite its relevance for pediatric blood pressure (BP) screening, the long-term predictive utility and natural progression of pediatric BP classification remain understudied.

To evaluate BP tracking from childhood to midadulthood using the American Academy of Pediatrics (AAP) thresholds and estimate transition probabilities among BP classifications over time considering multiple time points.

The analyses were performed in 2023 using data gathered from September 1980 to August 2018 within the longitudinal Cardiovascular Risk in Young Finns Study. Participants had BP examined 9 times over 38 years, from childhood (aged 6-12 years) or adolescence (15-18 years) to young adulthood (21-27 years), late young adulthood (30-37 years), and midadulthood (39-56 years).

BP classifications (normal, elevated, hypertension) were based on AAP guidelines for children and adolescents and the 2017 American College of Cardiology/American Heart Association guidelines for adults.

Outcomes were BP classifications at follow-up visits. Tracking coefficients were calculated using generalized estimated equations. Transition probabilities among BP classifications were estimated using multistate Markov models.

This study included 2918 participants (mean [SD] baseline age, 10.7 [5.0] years; 1553 female [53.2%]). Over 38 years, the tracking coefficient (odds ratio [OR]) for maintaining elevated BP/hypertension was 2.16 (95% CI, 1.95-2.39). Males had a higher probability than females of progressing to and maintaining hypertension and a lower probability of reverting to normal BP from childhood to midadulthood (transition probability: from normal BP to stage 2 hypertension, 0.20; 95% CI, 0.17-0.22 vs 0.08; 95% CI, 0.07-0.10; maintaining stage 2 BP, 0.32; 95% CI, 0.27-0.39 vs 0.14; 95% CI, 0.09-0.21; from stage 2 hypertension to normal BP, 0.23; 95% CI, 0.19-0.26 vs 0.58; 95% CI, 0.52-0.62. For both sexes, the probability of transitioning from adolescent hypertension to normal BP in midadulthood was lower (transition probability, ranging from 0.16; 95% CI, 0.14-0.19 to 0.44; 95% CI, 0.39-0.48) compared with childhood hypertension (transition probability, ranging from 0.23; 95% CI, 0.19-0.26 to 0.63; 95% CI, 0.61-0.66). The probability of maintaining normal BP sharply decreased in the first 5 to 10 years, stabilizing thereafter. Children with normal BP generally maintained this status into adolescence (male: transition probability, 0.64; 95% CI, 0.60-0.67; female: transition probability, 0.81; 95% CI, 0.79-0.84) but decreased by young adulthood (male: transition probability, 0.41; 95% CI, 0.39-0.44; female: transition probability, 0.69; 95% CI, 0.67-0.71).

Results of this cohort study reveal an enduring association of childhood and adolescent BP (AAP thresholds) with later BP. Although childhood normal BP tends to be maintained into adolescence, the probability of reverting to and sustaining normal BP decreases notably from adolescence to young adulthood. The findings of this study underscore the importance of prevention to maintain normal BP starting in childhood, suggesting adolescence as a potential critical period. The results suggest the potential for less frequent screenings for children with initially normal BP.

Vascular ageing (vascular ageing) is the deterioration of arterial structure and function which occurs naturally with age, and which can be accelerated with disease. Measurements of vascular ageing are emerging as markers of cardiovascular risk, with potential applications in disease diagnosis and prognosis, and for guiding treatments. However, vascular ageing is not yet routinely assessed in clinical practice. A key step towards this is the development of technologies to assess vascular ageing. In this Roadmap, experts discuss several aspects of this process, including: measurement technologies; the development pipeline; clinical applications; and future research directions. The Roadmap summarises the state of the art, outlines the major challenges to overcome, and identifies potential future research directions to address these challenges.

The importance of routine hypertension screening in children and adolescents is now well recognized. However, it is often undiagnosed in clinical practice, partly due to the reliance on a complex blood pressure (BP) percentile-based table with hundreds of cutoffs by age, sex, and height.

Many studies have explored simplified tools for screening hypertension in children and adolescents, such as simplified formulas, simplified BP tables by age and sex group, by age group, or by height group, and the BP to height ratio. Nevertheless, validation studies have demonstrated that these simplified tools are prone to yielding many false-positive cases or remain inconvenient to use in primary pediatric care settings and large-scale screening surveys. To address this issue, we propose adopting static BP cutoffs of 120/80 mmHg for children aged 6-12 years and 130/80 mmHg for adolescents aged 13-17 years to simplify the definition of hypertension. Our proposed static BP cutoffs have shown comparable performance to the complex BP percentile-based table in predicting subclinical cardiovascular damage in both childhood and adulthood.

We recommend using static BP cutoffs (120/80 mmHg for children and 130/80 mmHg for adolescents) to facilitate the screening of pediatric hypertension in clinical practice, thereby bridging the gap between perception and action.

Socioeconomic status has been related to resting blood pressure (BP) levels at different stages of life. However, the association of childhood socioeconomic status (SES) and adulthood exercise BP is largely unknown. Therefore, we studied the association of childhood SES with adulthood maximal exercise BP.

This investigation consisted of 373 individuals (53% women) participating in the Cardiovascular Risk in Young Finns Study who had data concerning family SES in childhood (baseline in 1980, at age of 6-18 years) and exercise BP response data in adulthood (follow-up in adulthood in 27-29 years since baseline). A maximal cardiopulmonary exercise test with BP measurements was performed by participants, and peak exercise BP was measured.

In stepwise multivariable analysis including childhood risk factors and lifestyle factors (body mass index, systolic BP, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, insulin, fruit consumption, vegetable consumption, and physical activity), lower family SES in childhood was associated with higher maximal exercise BP in adulthood (β value ± SE, 1.63 ± 0.77, p = 0.035). The association remained significant after further adjustment with participants SES in adulthood (β value ± SE, 1.68 ± 0.65, p = 0.011) and after further adjustment with adulthood body-mass index, systolic BP, maximal exercise capacity, and peak heart rate in exercise (β value ± SE, 1.25 ± 0.56, p = 0.027).

These findings suggest that lower childhood family SES is associated with higher maximal exercise BP in adulthood.

Pediatric high blood pressure (BP) predicts future cardiovascular disease events. High BP is improperly measured, underrecognized, and undermanaged especially in disadvantaged populations. In a large, diverse, academic pediatric practice, we detail the associations of a comprehensive initiative with high BP provider recognition.

A comprehensive BP initiative was promulgated including (1) retraining providers and staff on BP management; (2) deploying equipment at 55+ sites; and (3) electronic decision support tool alerting staff and clinicians and suggesting management. During the 14-month preintervention and 14-month postintervention periods, data on BP and patient characteristics were collected. The outcome was incident BP recognition defined as any of the following: BP-specific International Classification of Diseases, Tenth Revision, diagnosis; problem list entry; specialty referral; diagnostic testing; repeat visit; or antihypertensives. Dichotomized as under versus at or over 13 years of age, analyses utilized interrupted time series and multivariable-adjusted logistic regression.

From preintervention (children, n=105 674; adolescents, n=54 365) to postintervention (children, n=87 917; adolescents, n=56 470), the proportion measured with high BP declined in children and adolescents (30% versus 14% and 30% versus 15%, respectively, each P<0.001). Post-intervention, high BP provider recognition was 58% higher in children (4.6%-7.3%) and 43% higher in adolescents (7.9% versus 11.3%; P<0.001 for both). The improvement was not different in disadvantaged race, ethnicity, or zip codes.

A comprehensive BP initiative was associated with more appropriate high BP measurement and recognition including in disadvantaged populations. Future work may address the low overall and nonsustained recognition and consideration of electronic decision support for pediatric BP management and mitigating disparities.

This review summarizes current knowledge on blood pressure in children and adolescents (youth), with a focus on primary hypertension-the most common form of elevated blood pressure in this demographic. We examine its etiology, progression, and long-term cardiovascular implications. The review covers definitions and recommendations of blood pressure classifications, recent developments in measurement, epidemiological trends, findings from observational and clinical studies, and prevention and treatment, while identifying gaps in understanding and suggesting future research directions.

Youth hypertension is an escalating global issue, with regional and national variations in prevalence. While the principles of blood pressure measurement have remained largely consistent, challenges in this age group include a scarcity of automated devices that have passed independent validation for accuracy and a generally limited tolerance for ambulatory blood pressure monitoring. A multifaceted interplay of factors contributes to youth hypertension, impacting long-term cardiovascular health. Recent studies, including meta-analysis and sophisticated life-course modelling, reveal an adverse link between youth and life-course blood pressure and subclinical cardiovascular outcomes later in life. New evidence now provides the strongest evidence yet linking youth blood pressure with clinical cardiovascular events in adulthood. Some clinical trials have expanded our understanding of the safety and efficacy of antihypertensive medications in youth, but this remains an area that requires additional attention, particularly regarding varied screening approaches. This review outlines the potential role of preventing and managing blood pressure in youth to reduce future cardiovascular risk. A global perspective is necessary in formulating blood pressure definitions and strategies, considering the specific needs and circumstances in low- and middle-income countries compared to high-income countries.

The purpose of this article is to summarize disparities in blood pressure (BP) by race in the United States, discuss evidence-based strategies to increase equity in BP, review recent American Heart Association BP equity initiatives, and highlight missed opportunities for achieving equity in hypertension. Over 122 million American adults have hypertension, with the highest prevalence among Black Americans. Racial disparities in hypertension and BP control in the United States are estimated to be the single largest contributor to the excess risk for cardiovascular disease among Black versus White adults. Worsening disparities in cardiovascular disease and life expectancy during the COVID-19 pandemic warrant an evaluation of the strategies and opportunities to increase equity in BP in the United States. Racial disparities in hypertension are largely driven by systemic inequities that limit access to quality education, economic opportunities, neighborhoods, and health care. To address these root causes, recent studies have evaluated evidence-based strategies, including community health workers, digital health interventions, team-based care, and mobile health care to enhance access to health education, screenings, and BP care in Black communities. In 2021, the American Heart Association made a $100 million pledge and 10 commitments to support health equity. This commitment included implementing multifaceted interventions with a focus on hypertension as a seminal risk factor contributing to disparities in cardiovascular disease mortality and morbidity. The American Heart Association is one organizational example of advocacy for equity in BP. Achieving equity nationwide will require sustained collaboration among individual stakeholders and public, private, and community organizations to address barriers across multiple socioecological levels.

Hypertension has become a global medical and public health issue even in childhood. It is well accepted that hypertension is associated with impaired endothelium-dependent vascular reactivity in adult patients. However, there is a lack of data on hypertension-related endothelial dysfunction in hypertensive children. Thus, present study aimed to evaluate the association of primary hypertension in the pediatric population with macro- and microvascular function, and to assess the potential role of oxidative stress in that connection.

Fifty-two children were enrolled in this study; 26 normotensive (NT) and 26 with primary hypertension (HT), both sexes, 9-17 years old. In addition to anthropometric, hemodynamic and biochemical measurements, peripheral microvascular responses to occlusion (postocclusive reactive hyperemia, PORH), local heating (local thermal hyperemia, LTH), iontophoretically applied acetylcholine (AChID) and sodium nitroprusside (SNPID) were evaluated by laser Doppler flowmetry (LDF). Furthermore, brachial artery flow-mediated dilation (FMD) was measured and biomarker of oxidative stress was determined.

PORH, AChID and LTH were impaired in hypertensive compared to normotensive children, while SNPID did not differ between groups. FMD was decreased in hypertensive compared to normotensive children. Serum concentration of 8- iso -PGF2α was significantly elevated in hypertensive compared to normotensive children.

Even in childhood, primary hypertension is associated with attenuated endothelial function and reduced endothelium-dependent responses to various physiological stimuli. Juvenile hypertension is related to increased level of vascular oxidative stress. All changes are independent of BMI.

The existing evidence regarding the joint effect of heavy metals on blood pressure (BP) in children and adolescents is insufficient. Furthermore, the impact of factors such as body weight, fish consumption, and age on their association remains unclear.

The study utilized original data from the National Health and Nutrition Examination Survey, encompassing 2,224 children and adolescents with complete information on 12 urinary metals (barium, cadmium, cobalt, cesium, molybdenum, lead, antimony, thallium, tungsten, uranium, mercury and arsenic), BP, and core covariates. Various statistical methods, including weighted multiple logistic regression, linear regression, and Weighted Quantile Sum regression (WQS), were employed to evaluate the impact of mixed metal exposure on BP. Sensitivity analysis was conducted to confirm the primary analytical findings.

The findings revealed that children and adolescents with low-level exposure to lead (0.40 μg/L, 95%CI: 0.37, 0.42), mercury (0.38 μg/L, 95%CI: 0.35, 0.42) and molybdenum (73.66 μg/L, 95%CI: 70.65, 76.66) exhibited reduced systolic blood pressure (SBP) and diastolic blood pressure (DBP). Conversely, barium (2.39 μg/L, 95%CI: 2.25, 2.54) showed a positive association with increased SBP. A 25th percentile increase in the WQS index is significantly associated with a decrease in SBP of 0.67 mmHg (95%CI, -1.24, -0.10) and a decrease in DBP of 0.59 mmHg (95% CI, -1.06, -0.12), which remains statistically significant even after adjusting for weight. Furthermore, among individuals who consume fish, heavy metals have a more significant influence on SBP. A 25 percentile increase in the WQS index is significantly associated with a decrease of 3.30 mmHg (95% CI, -4.73, -1.87) in SBP, primarily attributed to mercury (27.61%), cadmium (27.49%), cesium (17.98%), thallium (8.49%). The study also identified a declining trend in SBP among children aged 10-17, whereas children aged 11-18 exhibited lower levels of systolic and diastolic blood pressure, along with a reduced risk of hypertension.

Some heavy metals demonstrate an inverse association with the BP of children and adolescents, particularly notable in groups with fish consumption and older children and adolescents. Future studies are warranted to validate these findings and delve deeper into the interplay of heavy metals.

Hypertension affects 6% of all children, and its prevalence is increasing. Childhood hypertension tracks into adulthood and is associated with subclinical cardiovascular disease; however, there is a lack of evidence linking childhood hypertension to cardiovascular outcomes, which may contribute to underdiagnosis and undertreatment.

To determine the long-term associated risk of major adverse cardiac events (MACE) among children diagnosed with hypertension.

This was a population-based, retrospective, matched cohort study conducted from 1996 to 2022. The study included all children (aged 3-18 years) alive in Ontario, Canada, from 1996 to 2021, who were identified using provincial administrative health databases. Children with prior kidney replacement therapy were excluded.

Incident hypertension diagnosis, identified by validated case definitions using diagnostic and physician billing claims. Each case was matched with 5 controls without hypertension by age, sex, birth weight, maternal gestational hypertension, prior comorbidities (chronic kidney disease, diabetes, cardiovascular surgery), and a propensity score for hypertension.

The primary outcome was MACE (a composite of cardiovascular death, stroke, hospitalization for myocardial infarction or unstable angina, or coronary intervention). Time to MACE was evaluated using the Kaplan-Meier method and Cox proportional hazards regression.

A total of 25 605 children (median [IQR] age, 15 [11-17] years; 14 743 male [57.6%]) with hypertension were matched to 128 025 controls without hypertension. Baseline covariates were balanced after propensity score matching, and prior comorbidities were uncommon (hypertension vs control cohort: malignancy, 1451 [5.7%] vs 7908 [6.2%]; congenital heart disease, 1089 [4.3%] vs 5408 [4.2%]; diabetes, 482 [1.9%] vs 2410 [1.9%]). During a median (IQR) of 13.6 (7.8-19.5) years of follow-up, incidence of MACE was 4.6 per 1000 person-years in children with hypertension vs 2.2 per 1000 person-years in controls (hazard ratio, 2.1; 95% CI, 1.9-2.2). Children with hypertension were at higher associated risk of stroke, hospitalization for myocardial infarction or unstable angina, coronary intervention, and congestive heart failure, but not cardiovascular death, compared with nonhypertensive controls.

Children diagnosed with hypertension had a higher associated long-term risk of MACE compared with controls without hypertension. Improved detection, follow-up, and control of pediatric hypertension may reduce the risk of adult cardiovascular disease.

This comprehensive review explores the various scenarios of atherosclerosis, a systemic and chronic arterial disease that underlies most cardiovascular disorders. Starting from an overview of its insidious development, often asymptomatic until it reaches advanced stages, the review delves into the pathophysiological evolution of atherosclerotic lesions, highlighting the central role of inflammation. Insights into clinical manifestations, including heart attacks and strokes, highlight the disease's significant burden on global health. Emphasis is placed on carotid atherosclerosis, clarifying its epidemiology, clinical implications, and association with cognitive decline. Prevention strategies, lifestyle modifications, risk factor management, and nuanced antithrombotic treatment considerations are critical to managing cardiovascular complications, thus addressing a crucial aspect of cardiovascular health.

Poor dietary quality is associated with adiposity and other risks of cardiovascular disease (CVD) in children. In Kuwait, although children's food choices are a concern, no studies have evaluated dietary quality relative to the risk of CVD in Kuwaiti schoolchildren. This study hypothesized that dietary quality using the Healthy Eating Index (HEI) is associated with CVD risk factors in children and that there are associated sex differences.

Our main objective was to evaluate the dietary quality of schoolchildren and investigate whether poor HEI scores are associated with CVD risk and if there are sex differences.

This was a cross-sectional study of Kuwaiti fifth graders (n = 313; 53% girls; mean age = 10.4 ± 0.4 years) who completed an adapted Block Kids 2004 food frequency questionnaire. Anthropometric, blood pressure, and biochemical data were also measured. HEI-2010 and HEI-2015 scores were calculated.

A general linear model and logistic regression were applied, controlling for moderate-vigorous physical activity (MVPA) and screen time (ST).

The total HEI-2010 and HEI-2015 scores were 58 and 52 points, respectively; a trend analysis indicated that more girls than boys had poor (≤50 points) HEI-2015 scores (p < 0.063). The maximum scores for total vegetables (p < 0.001), dairy (p < 0.034), and fatty acids (p < 0.01) were significantly higher in girls, while the maximum scores for whole grains (p < 0.046) and protein (p < 0.006), but not sodium (p < 0.009), were higher in boys. Obesity was inversely associated with poor total HEI 2010 and HEI 2015 scores (OR: 0.347, 95% CI: 0.234 - 0.516, p < 0.001 and OR: 0.561, 95% CI: 0.391-0.805, p < 0.002, respectively). However, the correlation was lost after adjustment for possible confounding factors.

Dietary quality for children overall in this study was low, and there was only a weak association between poor scores and elevated blood pressure and none between scores and obesity. These findings have public health implications and warrant further investigation and attention.

The purpose of this study was to examine the prevalence of hypertension in Korean adolescents, its long-term trends, and factors associated with the development of hypertension.

Data of the Korea National Health and Nutrition Examination Survey (KNHANES) from 2007 to 2020 were combined into three time periods (2007-2011, 2012-2016, and 2017-2020). A total of 11,146 Korean adolescents aged 10-18 were included in the analysis. The definition of hypertension was based on the 2017 American Academy of Pediatrics guidelines for hypertension.

The age-adjusted prevalence of hypertension was 5.47%, 7.85%, and 9.92% in 2007-2011, 2012-2016, and 2017-2020, respectively. Long-term trend analysis using Joinpoint analysis over the observation period showed a significantly increasing trend in hypertension prevalence with a mean annual percentage change of 6.4%. Boys, those aged 13-15, those aged 16-18, overweight/obese, and those living in urban areas were more likely to develop hypertension (OR 1.980, 1.492, 3.180, 2.943, and 1.330, respectively).

The prevalence of hypertension in Korean adolescents was higher than the global prevalence of hypertension and showed an increase over a 13-year period. Targeted strategies for prevention and early detection of hypertension are needed in this population.

In 2016 and 2017, respectively, new Canadian and US guidelines for diagnosis and management of pediatric hypertension (HTN) were published. Six years after their publication, it is unknown whether the recommendations have led to changes in primary care practice patterns.

To determine whether HTN guidelines are associated with changes in practice patterns among primary care clinicians.

This retrospective, multicenter, population-based cohort study was conducted across 3 phases: January 1, 2011, to December 31, 2015 (era 1), January 1, 2016, to December 31, 2017 (washout period), and January 1, 2018, to December 31, 2019 (era 2). Data were collected from 7 Canadian provinces using the Canadian Primary Care Sentinel Surveillance Network Electronic Medical Record database. Eligible participants included children and adolescents (aged ≥3 to <18 years) with 1 or more encounters in the database. Data analysis was conducted from February 2022 to February 2023.

Implementation of the 2016 Hypertension Canada and 2017 American Academy of Pediatrics guidelines.

The primary outcomes were annual BP screening documentation, high BP follow-up documentation at 6 months and 1-year, HTN prevalence, laboratory testing rates, and medication prescription rates. Interrupted time series analysis was used to assess the association of the introduction of the Canadian and US guidelines with outcomes.

The study included 343 191 children and adolescents (mean [SD] age at first encounter, 6.7 (4.6) years; 173 290 female [50.5%]; 169 901 male [49.5%]), including 235 094 patients in era 1 and 193 473 patients in era 2. In era 1, 55 550 patients (23.6%) had at least 1 BP measurement, and in era 2, 45 006 patients (23.3%) had at least 1 BP measurement. There was a significant increase in BP screening in era 2 from 26 876 of 148 554 screenings (18.1%) to 28 556 of 141 192 screenings (20.2%; β = 0.202; 95% CI, 0.009 to 0.390; P = .04), and the increasing trend was sustained. There was a significant decrease in the trend of follow-up of high BP measurement at 6 months (1265 of 4941 patients with BP measurements [25.6%] to 1718 of 7321 patients with BP measurements [23.5%]; β = -0.490; 95% CI, -0.758 to -0.223; P = .001) and 1 year (1974 of 4941 measurements [40.0%] to 2314 of 7321 measurements [31.6%]; β = -1.392; 95% CI, -1.573 to -1.212; P < .001) in era 2. The proportion of patients meeting HTN criteria significantly increased from 2540 of 55 550 patients (4.6%) in era 1 to 5690 of 45 006 patients (12.6%) in era 2 (β = 0.0210; 95% CI, 0.0021 to 0.0410; P = .03). There was no significant change in the trend of laboratory testing rates in era 2 (949 of 4941 patients tested [19.2%] to 1149 of 7321 patients tested [15.7%]; β = -0.159; 95% CI, -0.364 to 0.046; P = .12). The trend in prescribing of medications to patients with HTN also decreased in era 2 (1305 of 4941 patients prescribed medication [26.4%] to 1415 of 7321 patients prescribed medication [19.3%]; β = -0.605; 95% CI, -0.830 to -0.358; P < .001).

The findings of this cohort study within the Canadian primary care setting suggest that there was a significant increase in BP screening and HTN prevalence after the publication of national and international HTN guidelines; however, the follow-up of high BP was still suboptimal. Increasing rates of pediatric HTN emphasize the need for better adherence to pediatric HTN guidelines to improve care and outcomes.

Although cardiovascular disease (CVD) begins in early life, the extent to which blood pressure (BP) at different life stages contributes to CVD is unclear.

To determine the relative contribution of BP at different life stages across the early-life course from infancy to young adulthood with carotid intima-media thickness (IMT).

The analyses were performed in 2022 using data gathered from July 1989 through January 2018 within the Special Turku Coronary Risk Factor Intervention Project, a randomized, infancy-onset cohort of 534 participants coupled with annual BP (from age 7 months to 20 years), biennial IMT measurements (from ages 13 to 19 years), who were followed up with again at age 26 years.

BP measured from infancy (aged 7 to 13 months), preschool (2 to 5 years), childhood (6 to 12 years), adolescence (13 to 17 years), and young adulthood (18 to 26 years).

Primary outcomes were carotid IMT measured in young adulthood at age 26 years. Bayesian relevant life-course exposure models assessed the relative contribution of BP at each life stage.

Systolic BP at each life stage contributed to the association with young adulthood carotid IMT (infancy: relative weight, 25.3%; 95% credible interval [CrI], 3.6-45.8; preschool childhood: relative weight, 27.0%; 95% CrI, 3.3-57.1; childhood: relative weight, 18.0%; 95% CrI, 0.5-40.0; adolescence: relative weight, 13.5%; 95% CrI, 0.4-37.1; and young adulthood: relative weight, 16.2%; 95% CrI, 1.6-46.1). A 1-SD (at single life-stage) higher systolic BP accumulated across the life course was associated with a higher carotid IMT (0.02 mm; 95% CrI, 0.01-0.03). The findings for carotid IMT were replicated in the Cardiovascular Risk in Young Finns Study that assessed systolic BP from childhood and carotid IMT in adulthood (33 to 45 years).

In this cohort study, a life-course approach indicated that accumulation of risk exposure to BP levels at all life stages contributed to adulthood carotid IMT. Of those, the contribution attributed to each observed life stage was approximately equal. These results support prevention efforts that achieve and maintain normal BP levels across the life course, starting in infancy.

Lisinopril, an angiotensin-converting enzyme inhibitor, is a frequently prescribed antihypertensive drug in the paediatric population, while being used off-label under the age of 6 years in the USA and for all paediatric patients globally. The SAFEPEDRUG project (IWT-130033) investigated lisinopril pharmacokinetics in hypertensive paediatric patients corresponding with the day-to-day clinical population.

The dose-escalation pilot study included 13 children with primary and secondary hypertension who received oral lisinopril once daily in the morning; doses ranged from 0.05 to 0.2 mg kg-1 . Patients were aged between 1.9 and 17.9 years (median 13.5 years) and weight ranged between 9.62 and 97.2 kg (median 53.2 kg). All data were analysed using Monolix version 2020R1 (Lixoft, France) and R version 3.6.2.

A 1-compartment model with first-order absorption and first-order elimination optimally describes the data. Parameter estimates of absorption rate constant (0.075 h-1 [0.062, 0.088], typical value [95% confidence interval]), volume of distribution (31.38 L 70 kg-1 [10.5, 52.3]) and elimination clearance (24.2 L h-1 70 kg-1 [19.5, 28.9]) show good predictive ability. Significant covariate effects include total body weight on elimination clearance, and distribution volume and estimated glomerular filtration rate (eGFR) on elimination clearance. The effects of eGFR on the elimination clearance are optimally described by a linear effect centred around 105 mL min-1  1.73 m-2 . The effects of body weight were implemented using fixed allometric exponents centred around an adult weight of 70 kg.

Lisinopril dose and regimen adjustments for paediatric patients should include eGFR on top of weight adjustments. An expanded model characterizing the pharmacodynamic effect is required to identify the optimal dose and dosing regimen.

The association of childhood blood pressure (BP) and heart rate (HR) with intermediate markers of cardiovascular disease several decades later has been shown, but studies on more short-term outcomes are scarce. Using population-based data, this study investigates the association of four BP parameters and HR in childhood with three carotid markers for vascular remodeling one decade later.

At the 11-year follow-up, 4607 participants of the nationwide KiGGS cohort aged 14 to 28 years had semi-automated sonographic carotid intima media thickness (CIMT) measurements. We investigated associations of baseline (age 3-17 years) and follow-up SBP, DBP, mean arterial pressure (MAP), pulse pressure (PP) and resting heart rate (RHR), with CIMT and lumen diameter at or above the 90th percentile and distensibility coefficient at or below the tenth percentile in logistic regressions. Analyses were further adjusted using a composite cardiovascular risk (CVR) score of BMI, triglycerides, total/HDL-cholesterol-ratio and HbA1c.

SBP, DBP, MAP and RHR were significantly and similarly associated with all carotid measures 11 years later, for example an odds ratio (OR) of 1.17 [confidence interval (CI) 1.06-1.29] for one standard deviation SBP increase with elevated CIMT when adjusting for sex, age and CVR score. Cross-sectionally, the strongest association was found for MAP with reduced distensibility coefficient (OR 1.76; CI 1.59-1.94).

This population-based cohort study shows robust and consistent associations between childhood BP and RHR and three carotid measures of vascular remodeling only one decade later, clearly underscoring the potential importance of preventing high BP already early in the life course.

Background There is a growing concern regarding elevated blood pressure in adolescence. Children and adolescents with high blood pressure are at risk for adult hypertension. Being overweight and obese are important risk factors for hypertension. This study aimed to determine the prevalence of elevated blood pressure and its association with anthropometric risk factors among students of a pre-university girls' college. Methodology A cross-sectional study was conducted among 337 students at a pre-university girls' college aged 15-19 years in urban Bangalore. A self-administered, semi-structured, pretested questionnaire collected the sociodemographic details, family history, and lifestyle. Height, weight, waist circumference (WC), and hip circumference were measured. Standard cut-off levels were used for body mass index (BMI), WC, waist-hip ratio (WHR), and waist-height ratio (WHtR). Resting blood pressure was determined using a digital blood pressure monitor. It was classified into normotensive, pre-hypertension (>90th to <95th percentile), and hypertension (>95th percentile). Data were analyzed using SPSS version 18 (SPSS Inc., Chicago, IL, USA). Pre-hypertension and hypertension were considered as having elevated blood pressure. Results The prevalence of pre-hypertension and hypertension was 21.4% (n = 72, 95% confidence interval (CI) = 17.0-25.7) and 9.8% (n = 33, 95% CI = 6.6-13.0), respectively. The prevalence of overweight was 20.2% (n = 68, 95% CI = 15.9-24.5) and obesity was 12.2% (n = 41, 95% CI = 8.7-15.7). WC, WHR, and WHtR were abnormal in 34.7% (n = 117, 95% CI = 29.6-39.8), 47.5% (n = 160, 95% CI = 42.1-52.8), and 45.7% (n = 154, 95% CI = 50.4-51.0), respectively. There was a statistically significant correlation between systolic blood pressure and BMI (p < 0.001), WC (p < 0.001), and WHtR (p < 0.001), as well as diastolic blood pressure and BMI (p < 0.001), WC (p = 0.008), and WHtR (p = 0.011). Statistically significant differences in mean BMI (p = 0.004), WC (p < 0.001), WHR (p = 0.007), and WHtR (p = 0.001) between normal, pre-hypertensive, and hypertensive students were also noted. Conclusions Pre-hypertension and hypertension are fundamental problems in pre-university girl students. With a similarly increased prevalence of obesity and other anthropometric risk factors, students must be aware of hypertension and its risk factors.

Air pollution has been associated with the development of atherosclerosis; however, the pathophysiological mechanisms underlying pro-atherosclerotic effects of air pollution exposure remain unclear. We conducted a prospective panel study in Beijing and recruited 152 participants with four monthly visits from September 2019 to January 2020. Linear mixed-effect models were applied to estimate the associations linking short-term air pollution exposure to biomarkers relevant to ceramide metabolism, pro-inflammation (neutrophil extracellular traps formation and systemic inflammation) and pro-atherosclerotic responses (endothelial stimulation, plaque instability, coagulation activation, and elevated blood pressure). We further explored whether ceramides and inflammatory indicators could mediate the alterations in the profiles of pro-atherosclerotic responses. We found that significant increases in levels of circulating ceramides of 9.7% (95% CIs: 0.7, 19.5) to 96.9% (95% CIs: 23.1, 214.9) were associated with interquartile range increases in moving averages of ambient air pollutant metrics, including fine particulate matter (PM2.5), black carbon, particles in size fractions of 100-560 nm, nitrogen dioxide, carbon monoxide and sulfur dioxide at prior up to 7 days. Higher air pollution levels were also associated with activated neutrophils (increases in citrullinated histone H3, neutrophil elastase, double-stranded DNA, and myeloperoxidase) and exacerbation of pro-atherosclerotic responses (e.g., increases in vascular endothelial growth factor, lipoprotein-associated phospholipase A2, matrix metalloproteinase-8, P-selectin, and blood pressure). Mediation analyses further showed that dysregulated ceramide metabolism and potentiated inflammation could mediate PM2.5-associated pro-atherosclerotic responses. Our findings extend the understanding on potential mechanisms of air pollution-associated atherosclerosis, and suggest the significance of reducing air pollution as priority in urban environments.

Reference blood pressure (BP) values for Japanese children based on a large number of measurements by auscultation have not yet been established.

This was a cross-sectional analysis of data from a birth-cohort study. The data from the sub-cohort study conducted for children at the age of 2 years in the Japan Environment and Children's Study from April 2015 to January 2017 were analyzed. BP was measured via auscultation using an aneroid sphygmomanometer. Each participant was measured in triplicate, and the average value of two consecutive measurements with a difference of less than 5 mmHg was recorded. The reference BP values were estimated using the lambda-mu-sigma (LMS) method and compared with those obtained via the polynomial regression model.

Data from 3361 participants were analyzed. Although the difference between the estimated BP values by the LMS and the polynomial regression model was small, the LMS model was more valid based on the results of the fit curve of the observed values and regression models for each model. For 2-year-old children with heights in the 50th percentile, the 50th, 90th, 95th, and 99th percentile reference values of systolic BP (mmHg) for boys were 91, 102, 106, and 112, and that for girls were 90, 101, 103, and 109, respectively, and those of diastolic BP for boys were 52, 62, 65, and 71, and that for girls were 52, 62, 65, and 71, respectively.

The reference BP values for 2-year-old Japanese children were determined based on auscultation and were made available.

The association between hypertension in adulthood and cardiovascular morbidity and death is well known. Based on that association, a diagnosis of elevated blood pressure in children has been clinically interpreted as early cardiovascular disease. The objective of this review is to discuss historical data and new research on the relationship between elevated blood pressure and early preclinical and later adult cardiovascular disease. After summarizing the evidence, we will address the gaps in knowledge around Pediatric hypertension in an effort to stimulate research into the important role that control of blood pressure in youth may play in preventing adult cardiovascular disease.

Childhood hypertension can lead to cardiovascular morbidity and mortality in young adult life. We aim to improve compliance with the American Academy of Pediatrics recommended blood pressure (BP) guideline steps to 75% over 12 months in children 9 to 18 years old during well-child visits.

The providers were educated on American Academy of Pediatrics high BP clinical practice guidelines. We integrated the guideline steps into the electronic medical record (EMR) and analyzed outcome measures. The outcome measures were: (1) BP recorded in the chart, (2) screening done by simplified BP table by clinic staff, (3) repeat manual BP by the provider, (4) BP classification, (5) documentation of BP classification, (6) management plan, and (7) follow-up schedule. Specific interventions were made based on each plan-do-study-act (PDSA) cycle, including reeducating the guidelines, reemphasizing following the EMR steps, and providing providers with individualized feedback and alerts.

Six of 7 outcome measures (except repeat manual BP by provider) achieved 86%-100% range after the second PDSA cycle. The annotated run chart demonstrates that repeat manual BP by provider improved from 38% to 89% in the fourth PDSA cycle.

Pediatric residents who run well-child clinics improved adherence to pediatric high BP guidelines by providing education and integrating prompts and information into the EMR.

Parabens are widely used as antimicrobial preservatives in personal care products. Studies investigating obesogenic or cardiovascular effects of parabens show discordant results, while data on preschool children are lacking. Paraben exposure during early childhood could have profound cardiometabolic effects later in life.

In this cross-sectional study paraben concentrations [methyl (MeP), ethyl (EtP), propyl (PrP), butyl (BuP)] were measured by ultra-performance liquid chromatography/tandem mass spectrometry in 300 urinary samples of 4-6-year-old children of the ENVIRONAGE birth cohort. Paraben values below the limit of quantitation (LOQ) were imputed by censored likelihood multiple imputation. The associations between log-transformed paraben values and cardiometabolic measurements (BMI z-scores, waist circumference, blood pressure and retinal microvasculature) were analyzed in multiple linear regression models with a priori selected covariates. Effect modification by sex was investigated by including interaction terms.

Geometric means (geometric SD) of urinary MeP, EtP, and PrP levels above the LOQ were 32.60 (6.64), 1.26 (3.45), and 4.82 (4.11) μg/L, respectively. For BuP more than 96% of all measurements were below the LOQ. Regarding the microvasculature, we found direct associations between MeP and central retinal venular equivalent (β = 1.23, p = 0.039) and PrP with the retinal tortuosity index (x103)(β = 1.75, p = 0.0044). Furthermore, we identified inverse associations between MeP and ∑parabens with BMI z-scores (β = -0.067, p = 0.015 and β = -0.070, p = 0.014 respectively), and EtP with mean arterial pressure (β = -0.69, p = 0.048). The direction of association between EtP and BMI z-scores showed evidence for sex-specific differences with a direct trend in boys (β = 0.10, p = 0.060).

Already at young age paraben exposure is associated with potentially adverse changes in the retinal microvasculature.

Although insulin resistance is closely related to hypertension, the debate continues as to whether insulin resistance is a cause or a consequence of hypertension. This study investigated the associations of cord blood insulin concentration with blood pressure (BP) and hypertension in childhood and adolescence.

This study included 951 children enrolled from 1998 to 2012 and followed from birth onwards at the Boston Medical Center, Boston, MA. Cord blood insulin concentration was measured using a sandwich immunoassay. Hypertension in childhood and adolescence was defined based on the 2017 American Academy of Pediatrics Clinical Practice Guidelines.

The median (interquartile range) for cord blood insulin concentration was 12.1 (7.2-19.0) µIU/mL. The age range of BP measurements was 3 to 18 years (median, 10.6 years). Cord blood insulin concentration was positively associated with systolic and diastolic BP as well as the risk of hypertension at age 3 to 18 years. Compared with the lowest tertile of cord blood insulin concentration, the top tertile insulin concentration was associated with a 5.18 (95% CI, 1.97-8.39) percentile increase in systolic BP, 4.29 (95% CI, 1.74-6.84) percentile increase in diastolic BP, and 1.62-fold (95% CI, 1.27-2.08) higher risk of hypertension. The association between insulin and hypertension was stronger among children born preterm (P for interaction=0.048). Furthermore, preterm birth and childhood overweight or obesity enhanced the associations.

Our results suggest that elevated insulin concentration at birth plays a critical role in the early life origins of hypertension and support the hypothesis implicating insulin resistance in the etiology of hypertension.

To investigate the effect of surgical intervention on 24-h ABP in children with OSA. It was hypothesized that blood pressure would improve following adenotonsillectomy.

This was a two-centered investigator-blinded randomized controlled trial. Non-obese pre-pubertal children aged 6-11 years with OSA (obstructive apnea-hypopnea index, OAHI >3/h) underwent 24-h ABP monitoring at baseline and 9 months after the randomly assigned intervention, i.e. Early Surgery (ES) or Watchful Waiting (WW). Intention-to-treat analysis was performed.

137 subjects were randomized. Sixty-two (Age: 7.9y ± 1.3, 71% boys) and 47 (Age: 8.5y ± 1.6, 77% boys) participants from the ES and WW groups, respectively completed the study. Changes in ABP parameters were similar in the ES and WW groups (nighttime systolic BP z-scores: +0.03 ± 0.93 vs. -0.06 ± 1.04, p = 0.65; nighttime diastolic BP z-scores: -0.20 ± 0.95 vs. -0.02 ± 1.00, p = 0.35) despite a greater improvement in OSA in the ES group. However, a reduction in nighttime diastolic BP z-score correlated with improvements in OSA severity indexes (r = 0.21-0.22, p < 0.05), and a significant improvement in nighttime diastolic BP z-score [-0.43 ± 1.01, p = 0.027] following surgery was observed in participants with severe preoperative OSA (OAHI ≥10/h). The ES group had a significant increase in body mass index z-score after surgery [+0.27 ± 0.57, p < 0.001], which correlated with the increase in daytime systolic BP z-score (r = 0.2, p < 0.05).

Surgical treatment did not lead to significant improvements in ABP in OSA children except in those with more severe disease. The improvement in BP was partially masked by the weight gain following surgery.

The trial was registered with the Chinese Clinical Trial Registry (http://www.chictr.org.cn.

ChiCTR-TRC-14004131).

Cardiovascular (CV) risk factors such as dyslipidemia, hypertension, diabetes, and obesity are associated with an increased risk for CV events in adults. Noninvasive measures of vascular health are associated with these CV events and can potentially help risk stratify children with CV risk factors. The purpose of this review is to summarize recent literature regarding vascular health in children with cardiovascular risk factors.

Adverse changes in pulse wave velocity, pulse wave analysis, arterial distensibility, and carotid intima-media thickness are seen in children with CV risk factors supporting potential utility in risk stratification. Assessing vascular health in children can be challenging due to growth-related changes in vasculature, multiple assessment modalities, and differences in normative data. Vascular health assessment in children with cardiovascular risk factors can be a valuable tool for risk stratification and help identify opportunities for early intervention. Future areas of research include increasing normative data, improving conversion of data between different modalities, and increasing longitudinal studies in children linking childhood risk factors to adult CV outcomes.

Background The origins of sex differences in cardiovascular diseases are not well understood. We examined the contribution of childhood risk factors to sex differences in adult carotid artery plaques and intima-media thickness (carotid IMT). Methods and Results Children in the 1985 Australian Schools Health and Fitness Survey were followed up when they were aged 36 to 49 years (2014-19, n=1085-1281). Log binomial and linear regression examined sex differences in adult carotid plaques (n=1089) or carotid IMT (n=1283). Childhood sociodemographic, psychosocial, and biomedical risk factors that might contribute to sex differences in carotid IMT/plaques were examined using purposeful model building with additional adjustment for equivalent adult risk factors in sensitivity analyses. Women less often had carotid plaques (10%) than men (17%). The sex difference in the prevalence of plaques (relative risk [RR] unadjusted 0.59 [95% CI, 0.43 to 0.80]) was reduced by adjustment for childhood school achievement and systolic blood pressure (RR adjusted 0.65 [95% CI, 0.47 to 0.90]). Additional adjustment for adult education and systolic blood pressure further reduced sex difference (RR adjusted 0.72 [95% CI, 0.49 to 1.06]). Women (mean±SD 0.61±0.07) had thinner carotid IMT than men (mean±SD 0.66±0.09). The sex difference in carotid IMT (β unadjusted -0.051 [95% CI, -0.061 to -0.042]) reduced with adjustment for childhood waist circumference and systolic blood pressure (β adjusted -0.047 [95% CI, -0.057 to -0.037]) and further reduced with adjustment for adult waist circumference and systolic blood pressure (β adjusted -0.034 [95% CI, -0.048 to -0.019]). Conclusions Some childhood factors contributed to adult sex differences in plaques and carotid IMT. Prevention strategies across the life course are important to reduce adult sex differences in cardiovascular diseases.

Greenness has been linked to cardiovascular health; however, limited evidence is available regarding its association with coronary artery stenosis and biomarkers of myocardial injury. We aimed to assess these associations and examine their modification and mediation effects in patients with myocardial infarction (MI).

This study included 2030 patients with MI. The normalized difference vegetation index (NDVI) was used to characterize greenness exposure. We used a logistic regression model to explore the relationship between coronary artery stenosis and residential greenness, and applied linear regression models to assess the association of greenness with biomarkers of myocardial injury. The bootstrap method was used to explore whether potential variables mediated the associations. To further investigate the exposure-response curve describing these relationships, we developed restricted cubic spline models.

Compared to the lowest quartile of NDVI, the odds ratio (OR) (95 % confidence interval [CI]) for severe stenosis (≥75 % stenosis) was 0.68 (95 % CI: 0.47 to 0.98) for the third quartile. Participants in the highest greenness exposure quartile had lower levels of cardiac troponin I (cTnI), creatine kinase (CK), and creatine kinase isoenzyme (CKMB) than those in the lowest quartile (β = -0.22, 95 % CI: -0.40 to -0.05; β = -0.13, 95 % CI: -0.22 to -0.04; β = -0.07, 95 % CI: -0.14 to -0.003). The association between residential greenness and myocardial injury biomarkers was stronger in men and older participants. Mediation analyses revealed that the effects of greenness on coronary stenosis, cTnI, CK, and CKMB were mediated by systolic blood pressure (SBP) and diastolic blood pressure (DBP).

Higher greenness exposure was associated with coronary artery stenosis and reduced levels of myocardial injury biomarkers, including cTnI, CK, and CKMB. These associations may be partially mediated by SBP and DBP levels.