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Characterising the lipid profile of paediatric patients with anomalous aortic origins of a coronary artery

Published online by Cambridge University Press:  21 November 2024

Thomas S. Przybycien Open the ORCID record for Thomas S. Przybycien [Opens in a new window] ,
Kimberly Gray ,
Sameer Sidiq ,
Sandra Mihail ,
Tam T. Doan Open the ORCID record for Tam T. Doan [Opens in a new window] ,
Shagun Sachdeva ,
Dana Reaves-O’Neal ,
Ziyad Binsalamah  and
Silvana Molossi Open the ORCID record for Silvana Molossi [Opens in a new window]
Thomas S. Przybycien
Affiliation:
Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA
Kimberly Gray
Affiliation:
Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA
Sameer Sidiq
Affiliation:
Baylor College of Medicine, Houston, Texas, USA
Sandra Mihail
Affiliation:
Baylor College of Medicine, Houston, Texas, USA
Tam T. Doan
Affiliation:
Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA Coronary Artery Anomalies Program, The Lillie Frank Abercrombie Section of Cardiology, Texas Children’s Hospital, Houston, Texas, USA
Shagun Sachdeva
Affiliation:
Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA Coronary Artery Anomalies Program, The Lillie Frank Abercrombie Section of Cardiology, Texas Children’s Hospital, Houston, Texas, USA
Dana Reaves-O’Neal
Affiliation:
Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA Coronary Artery Anomalies Program, The Lillie Frank Abercrombie Section of Cardiology, Texas Children’s Hospital, Houston, Texas, USA
Ziyad Binsalamah
Affiliation:
Main Health Cardiovascular Surgery, Portland, Maine, USA
Silvana Molossi*
Affiliation:
Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA Coronary Artery Anomalies Program, The Lillie Frank Abercrombie Section of Cardiology, Texas Children’s Hospital, Houston, Texas, USA
*
Corresponding author: Silvana Molossi; Email: [email protected]
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Abstract

Background:

Lipid levels in paediatric patients with anomalous aortic origin of a coronary artery (AAOCA) have not previously been explored. Patients with CHD have an increased risk of atherosclerotic cardiovascular disease later in life compared to the general population. We aim to characterise the lipid profiles in paediatric patients with AAOCA and explore its relation to diagnosis, race/ethnicity, and exercise.

Methods:

Single institution retrospective cohort of 180 AAOCA paediatric patients (median age 13.7 years interquartile range 9.7–15.6, 66% male). Total cholesterol, HDL, LDL, triglycerides, total cholesterol to HDL ratio, and non-HDL cholesterol were evaluated across race/ethnicity, sex, type of AAOCA, documented ischaemia on imaging, exercise level, and surgery status. Normality of the data distribution for each lipid parameter was evaluated using Kolmogorov–Smirnov testing. Accordingly, Mann–Whitney U and t-tests were used to compare variables. The proportion of abnormal lipid levels by sex and race/ethnicity was calculated.

Results:

Total cholesterol was elevated in 29%, (51/177) of patients, HDL 37% (64/174), triglycerides 44% (72/165), LDL 16% (28/170), total cholesterol-HDL ratio 29%, (48/163), and non-HDL cholesterol 28% (47/165). Across subgroups categorised on the basis of surgery status, exercise level, AAOCA type, and sex, the mean and median levels for individual lipid parameters were normal. By race/ethnicity, Hispanic patients had significantly higher triglyceride (median 99, interquartile range 71–136.5, p = <0.001) and total cholesterol to HDL ratios (median 3.2, interquartile range 2.7–4.5, p = 0.014) versus non-Hispanic White and Black patients. Two-thirds of patients exercise recreationally.

Conclusion:

Hispanic patients have significantly elevated triglycerides and total cholesterol to HDL ratios compared to others. Longitudinal follow-up evaluating differences in long-term lipid status in patients with AAOCA and risk for cardiovascular events is warranted.

Keywords

Anomalous aortic origins of coronary arterieslipidscholesterolpaediatrics
Type
Original Article
Information
Cardiology in the Young , Volume 35 , Issue 2 , February 2025 , pp. 311 - 316
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Copyright
© The Author(s), 2024. Published by Cambridge University Press

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References

Molossi, S, Doan, T, Sachdeva, S. Anomalous coronary arteries: a state-of-the-art approach. Cardiol Clin 2023; 41 ( 1 ): 51–69. DOI: 10.1016/j.ccl.2022.08.005 CrossRefGoogle ScholarPubMed
Doan, TT, Wilkes, JK, O’Neal Reaves, DL, et al. Clinical presentation and medium-term outcomes of children with anomalous aortic origin of the left coronary artery: high-risk features beyond interarterial course. Circ Cardiovasc Interv 2023; 16 ( 5 ): e012635. DOI: 10.1161/CIRCINTERVENTIONS.122 CrossRefGoogle ScholarPubMed
Mercado, JR, Coble, WL, Thompson, PD. Premature atherosclerosis: a possible mechanism for symptoms in anomalous coronary arteries--report of a case. Conn Med 2010; 74 ( 2 ): 91–92.Google ScholarPubMed
Türkay, C, Gölbasi, I, Bayezid, Ö. A single coronary artery from the right sinus of valsalva associated with atherosclerosis. Acta Cardiol 2002; 57 ( 5 ): 377–379. DOI: 10.2143/AC.57.5.2005457 CrossRefGoogle ScholarPubMed
Giannakoulas, G, Dimopoulos, K, Engel, R, et al. Burden of coronary artery disease in adults with congenital heart disease and its relation to congenital and traditional heart risk factors. Am J Cardiol 2009; 103 ( 10 ): 1445–1450. DOI: 10.1016/j.amjcard.2009.01.353 CrossRefGoogle ScholarPubMed
Lui, GK, Fernandes, S, McElhinney, DB. Management of cardiovascular risk factors in adults with congenital heart disease. J Am Heart Assoc 2014; 3 (6): e001076. DOI: 10.1161/JAHA.114.001076 CrossRefGoogle ScholarPubMed
Roche, SL, Silversides, CK. Hypertension, obesity, and coronary artery disease in the survivors of congenital heart disease. Can J Cardiol 2013; 29 ( 7 ): 841–848. DOI: 10.1016/j.cjca.2013.03.021 CrossRefGoogle ScholarPubMed
Berenson, GS, Srinivasan, SR, Bao, W, Newman, WP, Tracy, RE, Wattigney, WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med 1998; 338 ( 23 ): 1650–1656. DOI: 10.1056/NEJM199806043382302 CrossRefGoogle Scholar
Magnussen, CG, Koskinen, J, Juonala, M, et al. A diagnosis of the metabolic syndrome in youth that resolves by adult life is associated with a normalization of high carotid intima-media thickness and type 2 diabetes mellitus risk: the bogalusa heart and cardiovascular risk in young finns studies. J Am Coll Cardiol 2012; 60 ( 17 ): 1631–1639. DOI: 10.1016/j.jacc.2012.05.056 CrossRefGoogle Scholar
Jacobs, DR, Woo, JG, Sinaiko, AR, et al. Childhood cardiovascular risk factors and adult cardiovascular events. New Engl J Med 2022; 386 ( 20 ): 1877–1888. DOI: 10.1056/nejmoa2109191 CrossRefGoogle ScholarPubMed
Franks, PW, Hanson, RL, Knowler, WC, et al. Childhood obesity, other cardiovascular risk factors, and premature death. N Engl J Med 2010; 362 (6): 485–493. DOI: 10.1056/NEJMoa0904130 CrossRefGoogle ScholarPubMed
Juonala, M, Viikari, JSA, Kähönen, M, et al. Childhood levels of serum apolipoproteins B and A-I predict carotid intima-media thickness and brachial endothelial function in adulthood. The cardiovascular risk in young finns study. J Am Coll Cardiol 2008; 52 ( 4 ): 293–299. DOI: 10.1016/j.jacc.2008.03.054 CrossRefGoogle ScholarPubMed
Zachariah, JP. Double-trouble: atherosclerotic risk factors and congenital heart disease. Curr Atheroscler Rep 2023; 25 ( 7 ): 417–426. DOI: 10.1007/s11883-023-01114-1 CrossRefGoogle ScholarPubMed
Ference, BA, Yoo, W, Alesh, I, et al. Effect of long-term exposure to lower low-density lipoprotein cholesterol beginning early in life on the risk of coronary heart disease: a mendelian randomization analysis. Ratio Pharmacother Cardiol 2013; 9 ( 1 ): 90–98. DOI: 10.1016/j.jacc.2012.09.017 CrossRefGoogle Scholar
Kusters, DM, Avis, HJ, de Groot, E, et al. Ten-year follow-up after initiation of statin therapy in children with familial hypercholesterolemia. JAMA 2014; 312 ( 10 ): 1055–1057. DOI: 10.1001/jama.2014.8892 CrossRefGoogle ScholarPubMed
Luirink, IK, Wiegman, A, Kusters, DM, et al. 20-year follow-up of statins in children with familial hypercholesterolemia. New Engl J Med 2019; 381 ( 16 ): 1547–1556. DOI: 10.1056/nejmoa1816454 CrossRefGoogle ScholarPubMed
Bonilla-Ramirez, C, Molossi, S, Caldarone, CA, Binsalamah, ZM. Anomalous aortic origin of the coronary arteries – state of the art management and surgical techniques, Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2021;24: 85–94. DOI: 10.1053/j.pcsu.2021.03.004 CrossRefGoogle ScholarPubMed
Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report. Vol 128. American Academy of Pediatrics; 2011. doi:10.1542/peds.2009-2107Cref23CrossRefGoogle Scholar
Doan, TT, Zea-Vera, R, Agrawal, H, et al. Myocardial ischemia in children with anomalous aortic origin of a coronary artery with intraseptal course. Circ Cardiovasc Interv 2020; 13 ( 3): DOI: 10.1161/CIRCINTERVENTIONS.119.008375 CrossRefGoogle ScholarPubMed
Suryanarayana, P, Kollampare, S, Riaz, I Bin, et al. Presence of anomalous coronary seen on angiogram is not associated with increased risk of significant coronary artery disease. Int J Angiol 2014; 23 ( 4 ): 243–246. DOI: 10.1055/s-0034-1384839 CrossRefGoogle Scholar
Shirani, J, Roberts, WC. Solitary coronary ostium in the aorta in the absence of other major congenital cardiovascular anomalies. J Am Coll Cardiol 1993; 21 ( 1 ): 137–143. DOI: 10.1016/0735-1097(93)90728-j CrossRefGoogle ScholarPubMed
Garg, N, Tewari, S, Kapoor, A, Kumar Gupta, D, Sinha, N. Primary congenital Anomalies of the coronary arteries: a coronary arteriographic study. Int J Cardiol 2000; 74 ( 1): 39–46. www.elsevier.com/locate/ijcardCrossRefGoogle ScholarPubMed
Topaz, O, Demarchena, EJ, Perin, E, Sommer, LS, Mallon, SM, Chahine, RA. Anomalous coronary arteries: angiographic findings in 80 patients. Intl J Cardiol 1992; 34 ( 2): 129–138.CrossRefGoogle ScholarPubMed
Samarendra, P, Kumari, S, Hafeez, M, Vasavada, BC, Sacchi, TJ. Anomalous circumflex coronary artery: benign or predisposed to selective atherosclerosis. Angiology 2001; 52 ( 8 ): 521–526. DOI: 10.1177/000331970105200803 CrossRefGoogle ScholarPubMed
Rigatelli, G, Gemelli, M, Zamboni, A, et al. Are coronary artery anomalies an accelerating factor for coronary atherosclerosis development? Angiology 2004; 55 ( 1 ): 29–35. DOI: 10.1177/000331970405500105 CrossRefGoogle ScholarPubMed
Mohsen, GA, Mohsin, KG, Forsberg, M, Miller, E, Taniuchi, M, Klein, AJP. Anomalous left circumflex artery from the right coronary cusp: a benign variant? J Invasive Cardiol 2013; 25 ( 6 ): 284–287.Google ScholarPubMed
Said, SA, de Voogt, WG, Bulut, S, et al. Coronary artery disease in congenital single coronary artery in adults: a dutch case series. World J Cardiol 2014; 6 ( 4 ): 196–204. DOI: 10.4330/wjc.v6.i4.196 CrossRefGoogle ScholarPubMed
Steinberger, J, Daniels, SR, Hagberg, N, et al. Cardiovascular health promotion in children: challenges and opportunities for 2020 and beyond: a scientific statement from the American heart association. Circulation 2016; 134 ( 12 ): e236–e255. DOI: 10.1161/CIR.0000000000000441 CrossRefGoogle ScholarPubMed
Sriram, S, St. Sauver, JL, Jacobson, DJ, et al. Temporal trends in lipid testing among children and adolescents: a population based study. Prev Med Rep 2017; 8: 267–272. DOI: 10.1016/j.pmedr.2017.11.001 CrossRefGoogle ScholarPubMed
Zachariah, JP, Shittu, T, Wang, Y. Lipid temporal trends in normal-weight youth. Am Heart J 2021; 231: 68–72. DOI: 10.1016/j.ahj.2020.10.050 CrossRefGoogle Scholar
Zachariah, JP, McNeal, CJ, Copeland, LA, et al. Temporal trends in lipid screening and therapy among youth from 2002 to 2012. J Clin Lipidol 2015; 9 ( 5 ): S77–S87. DOI: 10.1016/j.jacl.2015.06.014 CrossRefGoogle ScholarPubMed
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