ORIGINAL ARTICLE Aortic, carotid intima-media thickness and flow- mediated dilation as markers of early atherosclerosis in a cohort of pediatric patients with rheumatic diseases Emanuela Del Giudice 1 & Anna Dilillo 1 & Luciana Tromba 2 & Giuseppe La Torre 3 & Sara Blasi 2 & Fabrizio Conti 4 & Franca Viola 1 & Salvatore Cucchiara 1 & Marzia Duse 1 Received: 23 February 2017 /Revised: 22 May 2017 /Accepted: 25 May 2017 # International League of Associations for Rheumatology (ILAR) 2017 Abstract The aims of this study were to identify the presence of endothelial dysfunction as a marker of early atherosclerosis by measuring aortic and carotid intimal-medial thickness (aIMT and cIMT) and flow-mediated dilation (FMD) and their correlation with traditional and no traditional risk factors for atherosclerosis in children with rheumatic diseases. Thirty- nine patients (mean age 15.3 ± 5.7 years), 23 juvenile idio- pathic arthritis, 9 juvenile spondyloarthropathies, 7 connective tissue diseases (mean disease duration and onset respectively 5 ± 3.6 and 10 ± 5 years), and 52 healthy children matched for sex and age were enrolled. Demographic data (age, sex, famil- iarity for cardiovascular disease), traditional risk factors for atherosclerosis (BMI, active and passive smoking, dyslipid- emia), activity disease indexes (reactive count protein, eryth- rocyte sedimentation rate) autoantibodies, and complement tests were collected. aIMT, cIMT, and FMD were assessed following a standardized protocol by high-resolution ultrasonography. Patients resulted significantly more exposed to passive smoking and had a lower BMI and higher homo- cysteine level than controls. cIMT and aIMT were significant- ly higher in patients than controls (p < 0.001) and correlated with age at diagnosis (p < 0.001 r 0.516 and 0.706, respec- tively) but not with mean disease duration. FMD % was sig- nificantly reduced in patients compared to controls (p < 0.001). Subclinical atherosclerosis occurs in pediatric rheumatic diseases, mainly in early onset forms, and aIMT is an earlier marker of preclinical atherosclerosis. Premature en- dothelial dysfunction could be included in the follow-up of children with rheumatic disorders to plan prevention strategies of cardiovascular disease already in pediatrics. Keywords Aorticintimal-medialthickness . Atherosclerosis . Carotid intimal-medial thickness . Flow-mediated dilation . Pediatric rheumatic diseases Background Cardiovascular diseases (CVDs) are the most frequent cause of morbidity and mortality globally: more people die annually from CVDs than from any other causes and the annual cardio- vascular disease mortality is projected to increase from 17.5 million in 2012 to 22.2 million in 2030 [1, 2]. The atherosclerosis is recognized as the leading factor for developing CVDs and may begin in childhood, as document- ed by autoptic studies on children, reporting with the accumu- lation of lipid in the intima of arteries to form fatty streaks first in the distal aorta and later in the carotid arteries [2]. On the other hand, the atherosclerosis may be considered itself an inflammatory disease, because the first step of the atherogenesis is the inflammation of the vessel wall. Primarily, the intimate vascular structure is involved with Key messages • Chronic inflammation appears to play a role in the development of atherosclerosis in rheumatic diseases. • Subclinical atherosclerosis occurs in pediatric rheumatic diseases and aIMT might be an earlier marker. * Emanuela Del Giudice emanuela.delgiudice@gmail.com 1 Department of Paediatrics and Infant Neuropsychiatry, Sapienza University of Rome, Rome, Italy 2 Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy 3 Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy 4 Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy Clin Rheumatol DOI 10.1007/s10067-017-3705-7