Cardiovascular Risk Factors in Children. Main Findings of the Four Provinces Study

• Published in: Revista española de cardiologia 2007-05, Vol.60 (5), p.517-524
• Main Authors: Garcés, Carmen, de Oya, Manuel
• Format: Article
• Language: eng ; spa
• Subjects: Anthropometry; Child; Children; Coronary disease; Coronary Disease - epidemiology; Diet; Dieta; Enfermedad coronaria; Factores de riesgo; Genetic Predisposition to Disease; Genetics; Genética; Humans; Lipids; Lipids - blood; Lípidos; Niños; Obesidad; Obesity; Risk Factors; Spain - epidemiology
• ISSN: 1885-5857; 1885-5857; 1579-2242
• DOI: 10.1016/S1885-5857(07)60193-5

Atherosclerosis is a process that begins during the first few decades of life, progresses asymptomatically, and generally shows no clinical manifestations until adulthood. The Four Provinces study, which involved 1275 prepubertal children, was an investigation into childhood risk factors for atherosclerosis (e.g., diet, anthropometric variables, lipid levels, and some genetic factors) that may be related to the occurrence of coronary artery disease in adults. In this review, we summarize the study's most important findings. The Four Provinces study showed that several factors associated with the metabolic syndrome (i.e., obesity, and raised glucose and triglyceride levels), which can lead to coronary disease in adults, are already present in schoolchildren. What is more, children from provinces with high coronary disease mortality weighed more and had higher plasma triglyceride and glucose levels. A high percentage of children in all provinces studied had total cholesterol and low-density lipoprotein cholesterol plasma levels above the recommended values. Despite the presence of some positive features in the population as a whole, such as a raised high-density lipoprotein cholesterol level and low prevalence of the apolipoprotein-E ɛ4 allele, which is known to be related to cardiovascular risk, if the metabolic changes described above persist, the risk of cardiovascular disease in Spain can only increase in the future. These metabolic characteristics are associated with a high-fat, low-carbohydrate diet which is far from that currently recommended for children. Correction of this poor diet at an early age would have significant benefits for the prevention of cardiovascular disease. La aterosclerosis es un proceso que se inicia en las primeras décadas de la vida y evoluciona de forma asintomática, en general, sin expresión clínica hasta la edad adulta. En el estudio Cuatro Provincias hemos analizado, en 1.275 niños de edad prepuberal, factores de riesgo (dieta, variables antropométricas, concentraciones de lípidos, vitaminas y algunos determinantes genéticos) que pueden estar relacionados con la aparición de la enfermedad coronaria en la edad adulta. En esta revisión resumimos de forma global, las principales aportaciones del estudio. El estudio 4P ha reflejado que los aspectos relacionados con el síndrome metabólico (obesidad, concentraciones elevadas de glucosa y triglicéridos) que conducen a la enfermedad coronaria en el adulto están ya expresados en la