Relationship Between Vitamin D and High Sensitivity C-reactive Protein! and Its Effect on Vascular Structure and Function in Children!

Pratik Sandesara1 , Geetha Raghuveer 1,2 Laura Schoeneberg1, Dean Merrill1, Jasmine Singh1, Hongying Dai 2 !

1 University of Missouri-Kansas City School of Medicine; 2Children’s Mercy Hospital!

BACKGROUND!!•  There are several traditional risk factors

for heart disease including:!o  Increasing age!o  Tobacco smoke exposure!o  Hypertension!o  Dyslipidemia!o  Obesity !o  Family history of premature

coronary artery disease!o  Diabetes!

•  Carotid artery intima media thickness (CIMT) and vascular distensibility indices are subclinical non-traditional markers of atherosclerosis and precede clinical cardiovascular events.1!

•  Elevated high sensitivity C-reactive protein (hsCRP), and vitamin D deficiency are associated with inflammatory changes that have been associated with cardiovascular events in adults.2,3 !

!AIM!!•  To examine the effect of vitamin D

deficiency and hsCRP levels on CIMT and vascular distensibility in healthy and obese children.!

METHODS!!

Prospective, case controlled study.!!

Case group: Inclusion criteria - obese children (BMI ≥95th percentile for age and sex) aged 9-11 years old. !Control group: Inclusion criteria - age and gender matched to the case group within 3 months of birthdate, BMI < 85th percentile for age and sex, no history of systemic disease or active infections, no active medications and no history of tobacco smoke exposure.!!

• Data collection includes history, anthropometric, demographic, and laboratory data, CIMT measurements, vascular distensibility and indices.!!

Power analysis: Based on the primary outcomes variable, CIMT and an assumption that the control group mean CIMT=0.34 mm, case group mean CIMT=0.37 mm and standard deviation is 0.035 mm.4 nQuery Advisor shows that a sample size of 22 in each group will have 80% power to detect a difference in mean CIMT of 0.03 mm using t-test with a 0.05 two-sided significance level. !!

LIMITATIONS!• This study is currently ongoing so only 11/22 case group data is shown below. The control group data is not available yet. !

CIMT with cursor at “QRS” on the EKG!ANTICIPATED OUTCOMES!!•  Higher hsCRP levels in obese children

compared to control children.!•  Direct correlation between hsCRP levels

and CIMT.!•  Inverse correlation between hsCRP levels

and vascular distensibility indices. !•  Vitamin D level and hsCRP levels maybe

inversely correlated and this may result in a synergistic, adverse effect on CIMT and vascular distensibility indices.!

!REFERENCES!!1)  Groner JA, et al. Pediatric precursors of adult

cardiovascular disease: noninvasive assessment of early vascular changes in children and adolescents. Pediatrics 2006;118:1683-91.!

2)  Ridker PM, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med 2008;359:2195-207.!

3)  Lee JH, et al. Vitamin D deficiency an important, common, and easily treatable cardiovascular risk factor? J Am Coll Cardiol 2008;52:1949-56. !

4)  Kapiotis S, et al. A Proinflammatory State is detectable in obese children and is accompanied by functional and morphological vascular changes. Arterioscler Thromb Vasc Biol. November 2006; 2541-46.!

Case  Group  (n=11/22)    

Age  (years)   10±1  

Sex  (F/M)   9/2  

BMI  (%<le)   98±1.5  

Systolic  Blood  Pressure  (mmHg)   116±7    

Diastolic  Blood  Pressure  (mmHg)   63±5    

Case  Group  Lab  data  (n=11/22)  (Reference  Values)  

Triglycerides  (mg/dL)   171±101  (<100)  

LDL  (mg/dL)   129±46  (<110)  

HDL  (mg/dL)   45±12  (>45)  

HbA1c  (%)   5.5±0.3  (<5.8)  

AST  (units/L)   26±7  (<50)  

ALT  (units/L)   29±11  (<50)  

hsCRP  (n=8/11)   7±9  (<3)  

Vitamin  D  (ng/L)   28±7  (>30)