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. 2010 Jun;31(12):1502-10.
doi: 10.1093/eurheartj/ehq062. Epub 2010 Apr 25.

Determinants of vascular phenotype in a large childhood population: the Avon Longitudinal Study of Parents and Children (ALSPAC)

Ann E Donald  1 , Marietta Charakida, Emanuela Falaschetti, Debbie A Lawlor, Julian P Halcox, Jean Golding, Aroon D Hingorani, George Davey Smith, John E Deanfield
Affiliations

Determinants of vascular phenotype in a large childhood population: the Avon Longitudinal Study of Parents and Children (ALSPAC)

Ann E Donald et al. Eur Heart J. 2010 Jun.

Abstract

Aims: To assess the feasibility and reproducibility of non-invasive vascular assessment in a childhood population setting and identify the determinants of vascular phenotype in early life.

Methods and results: We studied 7557 children (age 9.8-12.3 years) participating in the Avon Longitudinal Study of Parents and Children (ALSPAC). Six research technicians underwent a 5-month training protocol to enable study of brachial artery endothelial function by flow-mediated dilatation (FMD) and arterial stiffness by carotid to radial pulse wave velocity (PWV) and brachial distensibility [distensibility coefficient (DC)]. Reproducibility studies were performed at the beginning, the middle, and the end of the study. A blinded repeat evaluation of a random selection of 3% of the cohort was also undertaken throughout the study. The effect of anthropometric and environmental factors on each measure was examined. Successful measures were obtained in 88, 95, and 87% of the studied children for FMD, PWV, and DC, respectively. The coefficients of variation between technicians for FMD, PWV, and DC were 10.5, 4.6, and 6.6% at the beginning of the study and reached 7.7, 4.1, and 10% at the end. Baseline vessel diameter and gender were important determinants of all the vascular measures, with a small effect of room and skin temperatures on FMD and PWV. Boys consistently had lower FMD and DC and higher PWV measures (P < 0.01 for all).

Conclusion: Reproducible, high-quality assessments of vascular structure and function in children can be made on a large scale in field studies by suitably trained non-specialist operators. This study provides an invaluable resource for assessing the impact of early influences, genetic, and environmental factors on arterial phenotype.

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Figures

Figure 1
Figure 1
Distributions of vascular measures by sex. Distribution of flow-mediated dilatation, pulse wave velocity, and distensibility coefficient in males and females in the ALSPAC cohort.
Figure 2
Figure 2
Reproducibility of vascular measures (Bland–Altman plots). The Bland–Altman plot for (A) flow-mediated dilatation, (B) pulse wave velocity, and (C) distensibility coefficient. Dotted lines represent the 95% confidence intervals.
Figure 3
Figure 3
Nomogram for flow-mediated dilatation according to the vessel baseline diameter. A negative linear association exists between baseline diameter and flow-mediated dilatation. For a specific baseline diameter, flow-mediated dilatation can be estimated for a 10- to 11-year-old child. The black line shows the 75th percentile, the circle dashed line the 50th percentile, and the rectangular dashed line the 25th percentile of the population.
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