Risk factors for left ventricular hypertrophy

Glucose control and lipid profiles — Janet H. Silverstein, MD

Lung biopsy in immunocompromised children — Robert W. Wilmott, MD

Risk factors for left ventricular hypertrophy — Stephen R. Daniels, MD, PhD

January 2013

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he longitudinal study by Maahs et al of a large multi-ethnic population of youth with type 1 diabetes demonstrates that improved blood glucose control leads to modest improvement of lipid profiles over a 2-year observation period. Glycated hemoglobin (A1c) deterioration resulted in a more atherogenic lipid profile and A1c improvement with a less atherogenic profile. The worse the blood glucose at the start, the greater the expected improvement of the lipid profile as glycemia improves. However, the efficacy of lowering the A1c by 2% from 10% to 8% was modest. Thus, it is clear that very high lipid levels will likely need lipid lowering medication, even with improvement in blood glucose control, because the magnitude of improvement is not great, whereas those with borderline high values can avoid medication with improved control. Article page 101<

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ung biopsies are often used in immunocompromised children with suspected infectious complications. Naiditch et al from Northwestern University Feinberg School of Medicine have reviewed the charts of 50 immunocompromised patients who underwent surgical lung biopsy to ascertain the benefit from the procedure. The results showed that biopsy provided a definitive histopathologic or microbiologic diagnosis in 50% of patients, the most common diagnosis being fungal infection. The authors discuss the morbidities of lung biopsy and the outcomes in their patients. Lung biopsy is easily performed thoracoscopically these days and, even in the era of bronchoalveolar lavage, seems to continue to have some value, especially for the diagnosis of fungal infection. Article page 133<

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ncreased left ventricular mass is an important risk factor for adverse cardiovascular outcomes in adults. It is associated with coronary heart disease and congestive heart failure. Children and adolescents also can have increased left ventricular mass so it is important to know which factors are associated with the development of left ventricular hypertrophy. In this issue of The Journal, Falkner et al evaluated the relative effect of obesity and high blood pressure on left ventricular mass in African American adolescents. They found that both obesity and blood pressure elevation are associated with increased left ventricular mass index and the effects appear to be additive. Markers of inflammation were not associated with increased left ventricular mass index. These results are important because they add to our understanding of ways to potentially prevent left ventricular hypertrophy in young individuals. Article page 94<

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