HDL-Cholesterol in Children and Adolescents with Congenital Heart Disease

Abstract Background Children and adolescents with congenital heart disease may be more likely to develop atherogenic cardiovascular diseases in adulthood. Therefore, the early identification of risk factors and intervention in childhood may be crucial for a good quality of life and longevity. Objectives To describe the distribution of high-density lipoprotein-cholesterol (HDL-c) levels and its association with socioeconomic, clinical and cardiovascular risk factors in children and adolescents with congenital heart disease. Methods Cross-sectional study with children and adolescents aged between 5 and 18 years, with congenital heart disease. Socioeconomic, clinical and cardiovascular risk factors were evaluated. HDL-c concentrations were evaluated by the direct method and categorized as desirable (>45 mg/dL), borderline (40-45 mg/dL) and low (<40 mg/dL). We also assessed the “undesirable” levels, consisting of the sum of “borderline” and “low” values for comparative purposes. The multivariate logistic regression analysis was used to evaluate the factor associated with undesirable HDL-c levels. A p<0.05 value was adopted as statistically significant. Results Mean HDL-c was 51.2 mg/dL (SD 12.6), with a prevalence of 33.2% of undesirable HDL-c. In the multivariate analysis, C-reactive protein levels ≥ 3mg/dL (OR 3.26; 95% CI 1.32-8.04), age ≥ 10 years old (OR: 2.11; 95% CI 1.12-3.99) and undesirable levels of triglycerides (OR 2.21; 95% CI 1.13-4.75) were associated with undesirable HDL-c. Conclusion In this sample of children and adolescents with congenital heart disease, almost one third presented low or borderline HDL-c levels. Age ≥10 years, C-reactive protein and triglycerides were associated with undesirable HDL-c levels. These factors should be considered in the prevention of cerebrovascular diseases in adulthood in this population.

摘要
背景：患有先天性心脏病（congenital heart disease）的儿童及青少年，成年后罹患致动脉粥样硬化性心血管疾病的风险可能更高。因此，在儿童时期早期识别危险因素并予以干预，对维持良好生活质量与延长寿命或至关重要。
研究目的：描述先天性心脏病患儿及青少年的高密度脂蛋白胆固醇（high-density lipoprotein-cholesterol，HDL-c）水平分布特征，及其与社会经济、临床及心血管危险因素的关联。
研究方法：本研究为横断面研究，纳入年龄介于5~18岁的先天性心脏病患儿及青少年。对受试者的社会经济因素、临床指标与心血管危险因素进行评估。采用直接检测法测定高密度脂蛋白胆固醇浓度，并将其划分为适宜水平（＞45 mg/dL）、临界水平（40~45 mg/dL）与降低水平（＜40 mg/dL）。为便于对比分析，本研究将临界水平与降低水平合并定义为“不良”水平。采用多因素logistic回归分析，评估与不良高密度脂蛋白胆固醇水平相关的影响因素，以P＜0.05作为统计学显著性阈值。
研究结果：本研究受试者的高密度脂蛋白胆固醇平均水平为51.2 mg/dL（标准差SD：12.6），不良高密度脂蛋白胆固醇水平的患病率为33.2%。多因素分析结果显示，C反应蛋白（C-reactive protein）≥3 mg/dL（比值比OR：3.26；95%置信区间CI：1.32~8.04）、年龄≥10岁（OR：2.11；95%CI：1.12~3.99）以及甘油三酯水平不良（OR：2.21；95%CI：1.13~4.75）与不良高密度脂蛋白胆固醇水平显著相关。
研究结论：在本研究纳入的先天性心脏病患儿及青少年样本中，近三分之一的人群存在高密度脂蛋白胆固醇降低或临界异常。年龄≥10岁、C反应蛋白水平异常及甘油三酯水平异常与不良高密度脂蛋白胆固醇水平相关。针对该人群，应将上述因素纳入成年后脑血管疾病的预防考量范畴。