Cardiovascular Risk Factor Trajectories and Their Association with Subclinical Atherosclerosis in Children and Adolescents with Congenital Heart Disease: Findings from a 5-Year Follow-up Study

Cardiovascular risk factors in children and adolescents with congenital heart disease (CHD) are well established, however follow-up studies evaluating changes in cardiovascular risk are scarce and necessary. This study aimed to evaluate the cardiovascular risk factors changes in children and adolescents with CHD and to investigate factors associated with carotid intima-media thickness at 5-year follow-up. This study included 101 children and adolescents with CHD. Clinical characteristics were assessed at baseline and follow-up. Lifestyle behaviors were evaluated at baseline. Cardiovascular risk factors changes were evaluated. Carotid intima-media thickness was measured using ultrasound at follow-up. Factors associated with carotid intima-media thickness at 5-year follow-up were examined using linear regressions and sensitivity analyses stratified by waist circumference changes was performed. The median WC and triglycerides significantly increased, while blood pressure, total cholesterol, low-density lipoprotein and non-high-density lipoprotein cholesterol significantly decreased over 5-years. In multivariable analyses, coarctation of aorta (β: 0.035 95%CI: 0.009;0.061) and increased waist circumference (β: 0.022 95%CI: 0.002;0.041) were associated with carotid intima-media thickness at 5-year follow-up. In sensitivity analyses, coarctation of aorta (β: 0.054 95%CI 0.002;0.087) and baseline unhealthy eating habits cluster (β: 0.031 95%CI 0.013;0.061) were associated with carotid intima-media thickness at 5-year follow-up only in increased waist circumference group. Children and adolescents with coarctation of aorta and increased waist circumference were prospectively associated with carotid intima-media thickness. These findings emphasize the importance of group-risk stratifications and early diagnosis and treatment of cardiovascular risk with multi-professional approach in this population.