European Journal of Cardiovascular Medicine

Ischemic heart disease (IHD) in the Indian population tends to present earlier, progress more rapidly, and behave more aggressively. In India, 52.2% of cardiovascular deaths occur before the age of 70, whereas in developed countries the proportion is only 22.8% [1]. Additionally, individuals from South India exhibit a higher susceptibility to IHD, largely due to lifestyle patterns and high carbohydrate intake [2]. The current burden of morbidity and mortality reflects long-standing exposure to behavioral risk factors such as unhealthy diet, low levels of physical activity, and increased tobacco use, as well as biological risk factors like obesity, hypertension (HTN), dyslipidemia, and diabetes mellitus (DM) [1].

HTN is a major contributor to severe health complications in adults and is well recognized as a predictor of cardiovascular morbidity and mortality [3,4]. Numerous studies over the past decades have highlighted the genetic influence on HTN and demonstrated familial clustering of blood pressure across various populations [5,6]. Research also indicates a rising trend in elevated blood pressure and HTN among children and adolescents [7], and those with higher blood pressure early in life are more likely to develop HTN and cardiovascular disease as adults [8]. Consequently, early detection and preventive measures in children with elevated blood pressure are essential. Understanding familial patterns of HTN between parents and offspring can help assess the risk of elevated blood pressure in younger populations, facilitating early prevention and management of cardiovascular conditions [9].

Children may have one or both parents affected by HTN and IHD, and conditions like DM, HTN, and IHD often coexist because HTN increases the likelihood of IHD, while DM predisposes individuals to both HTN and IHD. At any given time, one condition may be evident while another remains undetected [10]. Moreover, children with parental history of IHD have been shown to exhibit elevated levels of several lipid components, with total cholesterol being the most prominent [11].

Evidence also suggests that the risk of IHD can be significantly lowered through dietary changes and lifestyle modification, emphasizing the need for early interventions to delay or prevent the development of atherosclerosis.1 Overweight or obese children are particularly prone to dyslipidemia, especially when their waist circumference or body fat is elevated.12 Their lipid profiles commonly show reduced high-density lipoprotein cholesterol (HDL-C) and increased triglyceride levels [12,13]. Although low-density lipoprotein cholesterol (LDL-C) values may fall within the normal range, the particles can undergo structural alterations, becoming smaller, denser, and more atherogenic [14]. Given this background, the present study was undertaken to evaluate the lipid profile and BMI in children aged 5 to 15 years who have parents diagnosed with IHD and/or DM and/or HTN.

Study population: This is a case control study conducted with total of 130 children attending outpatient department or admitted for other minor secondary illness with parental history of IHD and/or DM and/or HTN at Department of Paediatrics, Hassan Institute of Medical Sciences (HIMS), Hassan, Karnataka, India. A written informed consent was taken from all the patients participating in the study. Inclusion criteria: Children aged 5-15 years with parental age of 30-60 years and Children with either or both parents suffering from IHD and/or DM and/or HTN were included in this study Exclusion criteria: Children with hemodynamically unstable, congenital heart disease, chronic kidney disease, chronic liver disease, hypothyroidism, Cushing’s disease, and parenteral use of drugs were excluded from the study. Study design: Children who met inclusion criteria i.e., with a parental history of IHD and/or DM and/or HTN were grouped in Case group (n=65) and children having no parental history of IHD and/or DM and/or HTN were grouped in Control group (n=65). Data collection: The socio-demographic, clinical examination and BMI data were recorded. BMI of the eligible children was documented and assessed according to the recommendations of Indian Academy of Paediatrics. BMI indicates total body fat mass and it was calculated by formula: Weight in kg/Height in meter [15]. BMI was compared with reference values, and where ≥ 25kg/m2 was considered as abnormal value. Fasting lipid profile was estimated by enzymatic colorimetric method in blood sample of study subjects after 8 hours of fasting and after ruling out the causes of secondary hypercholesterolemia viz. nephrotic syndrome, hypothyroidism and parenteral use of drugs. Lipid profile was also estimated in the blood samples of children aged 5 to 15 years that include cholesterol, triglycerides, HDL, LDL-C, very low-density lipoprotein (VLDL) of both Cases and Control groups. The lipid profiles were compared with reference values range. Statistical analysis: Data were entered in Microsoft Excel 2021 and statistical analysis was done using IBM Statistical Software for Social Sciences (SPSS) version 21. Categorical variables were represented in the form of percentages, and frequencies. Continuous variables were presented as descriptive statistics (Mean and Standard deviation). Categorical variables were analysed using the Chi-square test. Comparison of continuous variables between the study groups was done using independent sample t-test. p≤0.05 was considered statistically significant.

The results on socio-demographic characteristics of the study subjects were represented in Table 1. Results depicted that there was no statistically significant difference in distribution of patients between groups with regards to age (p = 0.600), gender (p = 0.720), socioeconomic status (p = 0.720), and diet history (p = 0.720). However, consumption of junk food ≥3 times/week by patients in cases group was relative higher proportion than those in control group (84.6% vs. 23.1%; p<0.0001).

The results on comparison of study subjects based on family history was plotted in Table 2. Results depicted that among the case group, majority of the study subjects i.e., 46.1% were born to hypertensive father followed by diabetic father (27.7%), diabetic mother (13.8%), and hypertensive mother (12.3%). The distribution of study subjects based on familial history was statistically significant (p<0.001).

The results on comparison of lipid profile were represented in Table 3. Results implied that the lipid profile such as total cholesterol (p<0.0001), triglycerides (p<0.0001), LDL-C (p = 0.001), and VLDL-C (p<0.0001) were significantly at higher levels in cases group compared to control group. Furthermore, HDL-C levels were significantly (p = 0.036) at lower levels in cases group compared to control group. In addition, ratio of TG/HDL was slightly higher in cases group than controls (4.09 vs. 3.68; p= 0.241).

The mean BMI in the cases and control groups was 18.33 kg/m² and 18.09 kg/m² respectively without any statistically significant difference (p = 0.198). There was no statistically significant (p = 0.357) difference in distribution of lean and normal proportion of study subjects among cases and control group (Table 4).

Table 1. Socio-demographic characteristics

Values were expressed as n (%)

Table 2. Comparison of family history

Values are expressed as n (%)

Table 3. Comparison of lipid profile

Values are expressed as mean ± SD;

LDL-C, Low-density lipoprotein-cholesterol; HDL-C, High-density lipoprotein-cholesterol; VLDL-C, Very low-density lipoprotein-cholesterol; TG, Triglycerides   

Table 4. Comparison of body mass index

Values are expressed as n (%) unless otherwise stated

Recognizing metabolic and cardiovascular risks early in children who have a family history of IHD, DM, and HTN is essential for timely preventive strategies. Evidence showed that precursors of Type 2 diabetes and cardiovascular disorders can appear during childhood, particularly among those with hereditary susceptibility. Family history thus serves as an important indicator for identifying children at elevated risk. Research confirms that children with first- or second-degree relatives affected by diabetes or cardiovascular diseases have a greater probability of developing these conditions themselves [16].

Lifestyle behaviors—especially diet and physical activity—also play a pivotal role in shaping metabolic risk [17]. Children born to families with obesity or cardiometabolic disorders commonly exhibit increased BMI and greater adiposity, highlighting the combined influence of genetic and environmental factors in childhood obesity [18]. Considering this background, the present case-control study aimed to assess lipid parameters—total cholesterol, triglycerides, LDL-C, HDL-C, VLDL-C, TG/HDL ratio—and BMI in children aged 5–15 years with parental history of IHD and/or DM and/or HTN.

The significant differences in lipid markers between children of diabetic parents and those of non-diabetic parents observed in our study are well supported by previous research. Numerous studies report that parental diabetes, particularly maternal diabetes, negatively affects the lipid profiles of offspring by increasing total cholesterol, LDL-C, VLDL-C, and triglycerides while lowering HDL-C. Makedou et al., found markedly higher mean total cholesterol and LDL-C in children with diabetic family history compared to controls [19]. These outcomes align with those of Pac et al., who reported that maternal history of Type 2 Diabetes correlated with elevated LDL-C levels [20]. Additionally, Makedou et al., in an investigation involving children with a family history of CHD or hyperlipidemia, reported significantly higher values of total cholesterol, triglycerides, LDL-C, and apolipoprotein B100 relative to controls [19].

Existing literature also emphasizes the usefulness of the TG/HDL-C ratio as a marker for insulin resistance and cardiovascular risk in both pediatric and adult populations [21]. Quijada et al., noted that obesity raises cardiovascular risk in children and that the TG/HDL-C ratio can reliably identify those with heightened susceptibility [22]. Concurrently, in our study the ratio of TG/HDL-C was non-significantly higher in the case group compared to the control group (4.77 vs. 4.09).

Our study further revealed a markedly higher intake of junk food among children with a parental history of IHD, DM, and HTN. Specifically, 84.62% of cases consumed junk food 3–4 times per week, compared to only 23.08% among controls—a highly significant difference (p < 0.0001). This pattern highlights the role of dietary behaviors in elevating metabolic risk among genetically predisposed children. Similar findings have been documented by Mascarenhas et al., who reported that unhealthy eating patterns, especially high junk-food consumption, contributed to unfavorable lipid profiles in 9-year-old schoolchildren [23]. Likewise, Singh et al., indicated that regular junk-food intake is a major driver of childhood obesity, further exacerbated by inactivity, media influence, and easy access to calorie-dense foods [24].

Despite these associations, our study found no significant difference in BMI between children with and without a family history of metabolic conditions such as IHD, DM, and HTN. This suggests that during childhood, BMI alone may not sufficiently reflect underlying metabolic risk, possibly because early metabolic changes may not yet be evident through anthropometric indicators. Supporting this, previous studies have shown that BMI is an unreliable measure of adiposity in young overweight or obese children and should not be used as the sole marker of metabolic health [25]. The presence of metabolic disorders in parents of the case group further highlights the strong genetic contribution to metabolic outcomes in offspring. The development of metabolic syndrome is widely considered to involve a complex interaction between inherited tendencies and environmental exposures [26].

Among the lipid profile, the triglycerides, VLDL, and LDL were higher, and HDL values were lower in the children with a family history of HTN and/or DM, and/or IHD without significant difference in BMI among cases and controls. The derangement of lipid profile in children with a parental history of HTN and/or DM and/or IHD could be suggestive of genetic predisposition. This study findings highlight the importance of early interventions to address modification of lifestyle factors in children at risk of developing metabolic disorders due to genetic predispositions.

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