Endothelial Peripheral Arterial Tonometry (Endo-PAT 2000) use in paediatric patients: a systematic review

Jenny Hayden, Gill O'Donnell, Isabelle deLaunois, Clodagh O'Gorman, Jenny Hayden, Gill O'Donnell, Isabelle deLaunois, Clodagh O'Gorman

Abstract

Objectives: Endo Peripheral Artery Tonometry (EndoPAT-2000) is a non-invasive technology for measuring endothelial dysfunction (ED). The reactive hyperaemia index (RHI) is resulted and is low when ED is present. We aim to synthesise the literature on paediatric ED that used Endo-PAT analysis.

Design: A comprehensive systematic review was conducted from January 2015 to March 2021. The databases included Cochrane, MEDLINE EBSCO, EMBASE (Ovid), PUBMED and CINAHL EBSCO. Exclusion criteria were: (1) If a study used a different device, for example, (2) If the study had no results. Inclusion criteria were: (1) Published in the English, (2) more than 50% of study subjects were in the paediatric age range, (3) data relevant to paediatric age range children could be extrapolated from all data, where not all study subjects were children.

Results: Following the removal of duplicates, 156 articles were initially identified. Following exclusion, 50 articles were included for review. We have subdivided these papers into different systems for ease of reference and have reported our findings in six tables: patients with type 1/2 diabetes, obesity, cardiovascular, respiratory, psychiatric conditions and miscellaneous diseases. For each, the study design, population, control group (if available), RHI results and conclusions were reported.

Conclusions: A number of papers using Endo-PAT for children with various chronic diseases have evidence of ED. However, in many cases, there has only been a single cohort study using Endo-PAT. Further studies are required to validate these findings and to help characterise the cardiovascular risk profile of children with chronic disease. Further studies are also required that will characterise more completely the cardiovascular risk profile of these children.Consensus on other vascular risk markers that could be included in future studies is ideal and if accomplished, this would facilitate meta-analyses of studies of relatively rare conditions.

Keywords: Change management; Community child health; Education & training (see Medical Education & Training); Organisational development; Paediatric endocrinology; Paediatrics.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 flow diagram of systematic search for Endo-PAT 2000 in paediatric populations. *Consider, if feasible to do so, reporting the number of records identified from each database or register searched (rather than the total number across all databases/registers).**If automation tools were used, indicate how many records were excluded by a human and how many were excluded by automation tools. From Page et al. EndoPAT-2000, Endo Peripheral Artery Tonometry.

References

    1. Mudau M, Genis A, Lochner A, et al. . Endothelial dysfunction: the early predictor of atherosclerosis. Cardiovasc J Afr 2012;23:222–31. 10.5830/CVJA-2011-068
    1. Avogaro A, Albiero M, Menegazzo L, et al. . Endothelial dysfunction in diabetes. Diabetes Care 2011;34:S285–90. 10.2337/dc11-s239
    1. Hadi HAR, Carr CS, Al Suwaidi J. Endothelial dysfunction: cardiovascular risk factors, therapy, and outcome. Vasc Health Risk Manag 2005;1:183–98.
    1. Taylor MS, Choi C-S, Bayazid L, et al. . Changes in vascular reactivity and endothelial Ca2+ dynamics with chronic low flow. Microcirculation 2017;24. 10.1111/micc.12354
    1. Leite AR, Borges-Canha M, Cardoso R, et al. . Novel biomarkers for evaluation of endothelial dysfunction. Angiology 2020;71:397–410. 10.1177/0003319720903586
    1. Haller MJ, Samyn M, Nichols WW, et al. . Radial artery tonometry demonstrates arterial stiffness in children with type 1 diabetes. Diabetes Care 2004;27:2911. 10.2337/diacare.27.12.2911
    1. Czippelova B, Turianikova Z, Krohova J, et al. . Arterial stiffness and endothelial function in young obese patients - vascular resistance matters. J Atheroscler Thromb 2019;26:1015–25. 10.5551/jat.47530
    1. Chang JC, Xiao R, Meyers KE, et al. . Nocturnal blood pressure dipping as a marker of endothelial function and subclinical atherosclerosis in pediatric-onset systemic lupus erythematosus. Arthritis Res Ther 2020;22:129. 10.1186/s13075-020-02224-w
    1. Bjornstad P, Nehus E, El Ghormli L, et al. . Insulin sensitivity and diabetic kidney disease in children and adolescents with type 2 diabetes: an observational analysis of data from the today clinical trial. Am J Kidney Dis 2018;71:65–74. 10.1053/j.ajkd.2017.07.015
    1. Franks PW, Hanson RL, Knowler WC, et al. . Childhood obesity, other cardiovascular risk factors, and premature death. N Engl J Med 2010;362:485–93. 10.1056/NEJMoa0904130
    1. La Valle A, Crocco M, Chiarenza DS, et al. . Endothelial impairment evaluation by peripheral arterial tonometry in pediatric endocrinopathies: a narrative review. World J Diabetes 2021;12:810–26. 10.4239/wjd.v12.i6.810
    1. Selamet Tierney ES, Newburger JW, Gauvreau K, et al. . Endothelial pulse amplitude testing: feasibility and reproducibility in adolescents. J Pediatr 2009;154:901–5. 10.1016/j.jpeds.2008.12.028
    1. Moerland M, Kales AJ, Schrier L, et al. . Evaluation of the EndoPAT as a tool to assess endothelial function. Int J Vasc Med 2012;2012:904141. 10.1155/2012/904141
    1. Fatihoglu SG, Jam F, Okutucu S, et al. . Noninvasive investigation of the presence and extent of coronary artery disease by the evaluation of fingertip-reactive hyperemia. Med Princ Pract 2022;31:262–8. 10.1159/000522098
    1. Bonetti PO, Pumper GM, Higano ST, et al. . Noninvasive identification of patients with early coronary atherosclerosis by assessment of digital reactive hyperemia. J Am Coll Cardiol 2004;44:2137–41. 10.1016/j.jacc.2004.08.062
    1. Wilk G, Osmenda G, Matusik P, et al. . Endothelial function assessment in atherosclerosis: comparison of brachial artery flow‑mediated vasodilation and peripheral arterial tonometry. Pol Arch Med Wewn 2013;123:443–52. 10.20452/pamw.1879
    1. Scaramuzza AE, Redaelli F, Giani E, et al. . Adolescents and young adults with type 1 diabetes display a high prevalence of endothelial dysfunction. Acta Paediatr 2015;104:192–7. 10.1111/apa.12877
    1. Babar G, Clements M, Dai H, et al. . Assessment of biomarkers of inflammation and premature atherosclerosis in adolescents with type-1 diabetes mellitus. J Pediatr Endocrinol Metab 2019;32:109–13. 10.1515/jpem-2018-0192
    1. Scaramuzza A, Giani E, Redaelli F, et al. . Alpha-Lipoic acid and antioxidant diet help to improve endothelial dysfunction in adolescents with type 1 diabetes: a pilot trial. J Diabetes Res 2015;2015:474561. 10.1155/2015/474561
    1. Nadeau KM, Nathan K, Bacha B, et al. . Effect of metformin on endothelial function in overweight adolescents with type 1 diabetes (T1D). Pediatric Diabetes 2016;17:152–3.
    1. Deda L, Yeshayahu Y, Sud S, et al. . Improvements in peripheral vascular function with vitamin D treatment in deficient adolescents with type 1 diabetes. Pediatr Diabetes 2018;19:457–63. 10.1111/pedi.12595
    1. Tomsa A, Klinepeter Bartz S, Krishnamurthy R, et al. . Endothelial function in youth: a biomarker modulated by adiposity-related insulin resistance. J Pediatr 2016;178:171–7. 10.1016/j.jpeds.2016.07.025
    1. Bacha F, Tomsa A, Bartz SK, et al. . Nonalcoholic fatty liver disease in Hispanic youth with dysglycemia: risk for subclinical atherosclerosis? J Endocr Soc 2017;1:1029–40. 10.1210/js.2017-00257
    1. Bacha . Circulating fibroblast growth factor-21 (FGF-21): a biomarker of subclinical atherosclerosis in obese youth with non-alcoholic fatty liver disease (NAFLD)? 88, 2017.
    1. Bartz SK, Caldas MC, Tomsa A, et al. . Urine Albumin-to-Creatinine ratio: a marker of early endothelial dysfunction in youth. J Clin Endocrinol Metab 2015;100:3393–9. 10.1210/JC.2015-2230
    1. Kochummen E, Umpaichitra V, Marwa A, et al. . Assessment of microvascular function in children and adolescents with diabetes and obesity. Int J Endocrinol Metab 2020;18:e90094. 10.5812/ijem.90094
    1. Bacha F, Bartz SK, Tomsa A, et al. . Free vitamin D: relationship to insulin sensitivity and vascular health in youth. J Pediatr 2019;212:28–34. 10.1016/j.jpeds.2019.04.057
    1. Djurica D, Holt RR, Ren J, et al. . Effects of a dietary strawberry powder on parameters of vascular health in adolescent males. Br J Nutr 2016;116:639–47. 10.1017/S0007114516002348
    1. Hussid MF, Jordão CP, Lopes‐Vicente WR, et al. . Flow‐ediated dilation in obese adolescents: correlation with waist circumference and systolic blood pressure. Faseb J 2018;32:713.7–7. 10.1096/fasebj.2018.32.1_supplement.713.7
    1. Donghui T, Shuang B, Xulong L, et al. . Improvement of microvascular endothelial dysfunction induced by exercise and diet is associated with microRNA-126 in obese adolescents. Microvasc Res 2019;123:86–91. 10.1016/j.mvr.2018.10.009
    1. Mu K, Zhang Y, Niu DY, et al. . [Distribution of peripheral arterial stiffness and endothelial function as well as their correlations with cardiovascular risk factors in children and adolescents]. Zhonghua Liu Xing Bing Xue Za Zhi 2016;37:805–9. 10.3760/cma.j.issn.0254-6450.2016.06.013
    1. Del Ry S, Cabiati M, Bianchi V, et al. . C-type natriuretic peptide plasma levels and whole blood mRNA expression show different trends in adolescents with different degree of endothelial dysfunction. Peptides 2020;124:170218. 10.1016/j.peptides.2019.170218
    1. Del Ry S, Cabiati M, Bianchi V, et al. . C-type natriuretic peptide is closely associated to obesity in Caucasian adolescents. Clin Chim Acta 2016;460:172–7. 10.1016/j.cca.2016.06.045
    1. Bacha F, Tomsa A, Bartz SK, et al. . Nonalcoholic fatty liver disease in Hispanic youth with dysglycemia: risk for subclinical atherosclerosis? J Endocr Soc 2017;1:1029–40. 10.1210/js.2017-00257
    1. Larsen MN, Nielsen CM, Madsen M, et al. . Cardiovascular adaptations after 10 months of intense school-based physical training for 8- to 10-year-old children. Scand J Med Sci Sports 2018;28 Suppl 1:33–41. 10.1111/sms.13253
    1. Czippelova BTZ, Krohova J, Lazarova Z. Endothelial function and arterial stifness in obese adolescents - A relation to barorefex function. Obes Facts 2017;10 10.5551/jat.47530
    1. Czippelova BTZ, Lazarova Z, Krohova J, et al. . Obesity in children and adolescents: a relation to endothelial function and arterial stiffness. Acta Physiologica 2016;217.
    1. Noma K, Kihara Y, Higashi Y. Outstanding effect of physical exercise on endothelial function even in children and adolescents. Circ J 2017;81:637–9. 10.1253/circj.CJ-17-0291
    1. Fusco E, Pesce M, Bianchi V, et al. . Preclinical vascular alterations in obese adolescents detected by laser-Doppler flowmetry technique. Nutr Metab Cardiovasc Dis 2020;30:306–12. 10.1016/j.numecd.2019.09.007
    1. Jehlicka PHM, Masopustova A, Trefil L, et al. . Reactive hyperaemia index and detection of endothelial dysfunction in children with familial hypercholesterolaemia. European Heart Journal 2015;36:262.
    1. Butbul Aviel Y, Dafna L, Pilar G, et al. . Endothelial function in children with a history of Henoch Schonlein purpura. Pediatr Rheumatol Online J 2017;15:3. 10.1186/s12969-016-0135-z
    1. Sciatti E, Cavazzana I, Vizzardi E, et al. . Systemic lupus erythematosus and endothelial dysfunction: a close relationship. Curr Rheumatol Rev 2019;15:177–88. 10.2174/1573397115666181126105318
    1. Negishi JOH, Hayama Y, Noritake K. Digital assessment of endothelial function and its association with clinical variable in patients with fontan operation. Cardiol Young 2016;26:S134. 10.1159/000489691
    1. Nozaki Y, Nakayama-Inaba K, Ishizu T, et al. . Endothelial dysfunction of conduit arteries in patients with repaired coarctation of the aorta. Int Heart J 2018;59:1340–5. 10.1536/ihj.17-564
    1. Augusto LS, Silva GC, Pinho JF, et al. . Vascular function in asthmatic children and adolescents. Respir Res 2017;18:17. 10.1186/s12931-016-0488-3
    1. Ysebaert M, Bruyndonckx L, De Winter B. The effect of weight loss on endothelial function and sleepdisordered breathing in obese children. Obes Facts 2018;11:225–6. 10.1159/000489691
    1. Zhang F, Wu Y, Feng G, et al. . Polysomnographic correlates of endothelial function in children with obstructive sleep apnea. Sleep Med 2018;52:45–50. 10.1016/j.sleep.2018.07.023
    1. Xu ZF, Zhang FJ, Ge WT, et al. . [Endothelial dysfunction in children with obstructive sleep apnea syndrome]. Zhonghua Er Ke Za Zhi 2020;58:13–18. 10.3760/cma.j.issn.0578-1310.2020.01.005
    1. Olive LS, Abhayaratna WP, Byrne D, et al. . Do self-reported stress and depressive symptoms effect endothelial function in healthy youth? The look longitudinal study. PLoS One 2018;13:e0196137. 10.1371/journal.pone.0196137
    1. Naiberg MR, Hatch JK, Selkirk B, et al. . Retinal photography: a window into the cardiovascular-brain link in adolescent bipolar disorder. J Affect Disord 2017;218:227–37. 10.1016/j.jad.2017.04.066
    1. Olive LS. Youth psychological distress and intermediary markers of risk for CVD: the emerging field of pediatric psychocardiology. Atherosclerosis 2017;261:158–9. 10.1016/j.atherosclerosis.2017.04.003
    1. Ruble K, Davis CL, Han H-R. Endothelial health in childhood acute lymphoid leukemia survivors: pilot evaluation with peripheral artery tonometry. J Pediatr Hematol Oncol 2015;37:117–20. 10.1097/MPH.0000000000000122
    1. Broberg O, Maxedius A, Öra I, et al. . Peripheral arterial structure and function in young survivors of childhood cancer. Cardiol Young 2018;28:118. 10.1017/S1047951118000318
    1. Broberg OOI, Maxedius A, Wiebe T, et al. . Peripheral vascular endothelial function is impaired in childhood cancer survivors. Cardiol Young 2016;26:36. 10.1017/S1047951116000500
    1. Pao E, Gove NE, Flynn JT, et al. . Ambulatory blood pressure and endothelial dysfunction in hematopoietic cell transplantation recipients. Biol Blood Marrow Transplant 2018;24:1678–84. 10.1016/j.bbmt.2018.04.024
    1. Borenstein-Levin L, Brik R, Pillar G, et al. . [Early detection of endothelial dysfunction in children with autoimmune diseases by a novel noninvasive technique]. Harefuah 2017;156:411–4.
    1. Yano S, Moseley K, Azen C. Detection of early end-organ damage by endothelial dysfunction with reactive hyperemia-digital peripheral arterial tonometry in patients with Fabry disease. Mol Genet Metab 2017;120:S143. 10.1016/j.ymgme.2016.11.380
    1. Yano SMK, Azen C. Evaluation of endothelial function with reactive hyperemia-digital peripheral arterial tonometry as a non-invasive biomarker to reflect vascular pathology in patients with Fabry disease. J Inborn Errors Metab Screen 2017;5:306–7.
    1. Al Jasmi F, Al Zaabi N, Al-Thihli K, et al. . Endothelial dysfunction and the effect of arginine and citrulline supplementation in children and adolescents with mitochondrial diseases. J Cent Nerv Syst Dis 2020;12:1–6. 10.1177/1179573520909377
    1. Winderman RRS, Vaidy K, Schwarz S. Vascular endothelial function in inflammatory bowel disease (IBD). J Pediatr Gastroenterol Nutr 2018;67:S79–80.
    1. Petr J, Michal H, Jan S, et al. . Reactive hyperaemia index as a marker of endothelial dysfunction in children with Crohn's disease is significantly lower than healthy controls. Acta Paediatr 2014;103:e55–60. 10.1111/apa.12467
    1. Dirajlal-Fargo S, Yu J, Albar Z, et al. . Monocyte activation and gut barrier dysfunction in South African youth on antiretroviral therapy and their associations with endothelial dysfunction. AIDS 2020;34:1615–23. 10.1097/QAD.0000000000002615
    1. Dirajlal-Fargo S, Sattar A, Kulkarni M, et al. . HIV-positive youth who are perinatally infected have impaired endothelial function. AIDS 2017;31:1917–24. 10.1097/QAD.0000000000001556
    1. Barber BE, William T, Grigg MJ, et al. . Nitric oxide-dependent endothelial dysfunction and reduced arginine bioavailability in Plasmodium vivax malaria but no greater increase in intravascular hemolysis in severe disease. J Infect Dis 2016;214:1557–64. 10.1093/infdis/jiw427
    1. Shah AS, Urbina EM. Vascular and endothelial function in youth with type 2 diabetes mellitus. Curr Diab Rep 2017;17:1–7. 10.1007/s11892-017-0869-0
    1. Naylor LH, Davis EA, Kalic RJ, et al. . Exercise training improves vascular function in adolescents with type 2 diabetes. Physiol Rep 2016;4. 10.14814/phy2.12713
    1. Tryggestad JB, Willi SM. Complications and comorbidities of T2DM in adolescents: findings from the today clinical trial. J Diabetes Complications 2015;29:307–12. 10.1016/j.jdiacomp.2014.10.009
    1. Jodele S, Dandoy CE, Myers KC, et al. . New approaches in the diagnosis, pathophysiology, and treatment of pediatric hematopoietic stem cell transplantation-associated thrombotic microangiopathy. Transfus Apher Sci 2016;54:181–90. 10.1016/j.transci.2016.04.007
    1. Leisenring WM, Mertens AC, Armstrong GT, et al. . Pediatric cancer survivorship research: experience of the childhood cancer Survivor study. J Clin Oncol 2009;27:2319–27. 10.1200/JCO.2008.21.1813
    1. Rajendran R, Abu E, Fadl A, et al. . Late effects of childhood cancer treatment: severe hypertriglyceridaemia, central obesity, non alcoholic fatty liver disease and diabetes as complications of childhood total body irradiation. Diabet Med 2013;30:e239–42. 10.1111/dme.12234
    1. Baker KS, Chow E, Steinberger J. Metabolic syndrome and cardiovascular risk in survivors after hematopoietic cell transplantation. Bone Marrow Transplant 2012;47:619–25. 10.1038/bmt.2011.118
    1. Friedman DN, Hilden P, Moskowitz CS, et al. . Cardiovascular risk factors in survivors of childhood hematopoietic cell transplantation treated with total body irradiation: a longitudinal analysis. Biol Blood Marrow Transplant 2017;23:475–82. 10.1016/j.bbmt.2016.12.623
    1. Brouwer CAJ, Postma A, Hooimeijer HLH, et al. . Endothelial damage in long-term survivors of childhood cancer. J Clin Oncol 2013;31:3906–13. 10.1200/JCO.2012.46.6086
    1. Jehlicka P, Huml M, Votava T, et al. . P8.05 reactive hyperemia index and detection of endothelial dysfunction in paediatric hemato/oncology patients. Artery Res 2011;5:184. 10.1016/j.artres.2011.10.127
    1. Mavinkurve M, O'Gorman CS. Cardiometabolic and vascular risks in young and adolescent girls with Turner syndrome. BBA Clin 2015;3:304–9. 10.1016/j.bbacli.2015.04.005
    1. O'Gorman CS, Syme C, Bradley T, et al. . Impaired endothelial function in pediatric patients with turner syndrome and healthy controls: a case-control study. Int J Pediatr Endocrinol 2012;2012:5. 10.1186/1687-9856-2012-5
    1. Pinto FF, Gomes I, Loureiro P, et al. . Vascular function long term after Kawasaki disease: another piece of the puzzle? Cardiol Young 2017;27:488–97. 10.1017/S1047951116000780
    1. Dietz SM, Tacke CEA, Hutten BA, et al. . Peripheral endothelial (Dys) function, arterial stiffness and carotid intima-media thickness in patients after Kawasaki Disease: a systematic review and meta-analyses. PLoS One 2015;10:e0130913. 10.1371/journal.pone.0130913
    1. Goldstein BH, Marino BS, Gao Z, et al. . Abstract 13486: patient and procedural factors are associated with autonomic and endothelial dysfunction in adolescent and young adult Fontan survivors. Circulation 2016;134:A13486. 10.1161/circ.134.suppl_1.13486
    1. Martins JD, Zachariah J, Selamet Tierney ES, et al. . Impact of Treatment Modality on Vascular Function in Coarctation of the Aorta: The LOVE - COARCT Study. J Am Heart Assoc 2019;8:e011536. 10.1161/JAHA.118.011536
    1. Goldstein BH, Urbina EM, Khoury PR, et al. . Abstract 13536: vascular function is predictive of functional outcomes in adolescent and young adult Fontan survivors. Circulation 2015;132. 10.1161/circ.132.suppl_3.13536
    1. Harris SL, Bray H, Troughton R, et al. . Cardiovascular outcomes in young adulthood in a population-based very low birth weight cohort. J Pediatr 2020;225:74–9. 10.1016/j.jpeds.2020.06.023
    1. Sivamurthy KM, Dampier C, MacDermott M, et al. . Peripheral arterial tonometry in assessing endothelial dysfunction in pediatric sickle cell disease. Pediatr Hematol Oncol 2009;26:589–96. 10.3109/08880010903271689
    1. Bhangoo A, Sinha S, Rosenbaum M, et al. . Endothelial function as measured by peripheral arterial tonometry increases during pubertal advancement. Horm Res Paediatr 2011;76:226–33. 10.1159/000328455
    1. Mueller UM, Walther C, Adam J, et al. . Endothelial function in children and adolescents is mainly influenced by age, sex and physical activity - an analysis of Reactive hyperemic peripheral artery tonometry. Circ J 2017;81:717–25. 10.1253/circj.CJ-16-0994
    1. Page MJ, McKenzie JE, Bossuyt PM, et al. . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. 10.1136/bmj.n71
    1. Singh R, Verma A, Aljabari S, et al. . Urinary biomarkers as indicator of chronic inflammation and endothelial dysfunction in obese adolescents. BMC Obes 2017;4:11. 10.1186/s40608-017-0148-2
    1. Bruyndonckx LMF, Verhulst S, De Guchtenaere A, et al. . Prevalence of type D personality in obese adolescents and associated cardiovascular risk. Cardiol Young 2018;28.
    1. Pareyn A, Allegaert K, Verhamme P, et al. . Impaired endothelial function in adolescents with overweight or obesity measured by peripheral artery tonometry. Pediatr Diabetes 2015;16:98–103. 10.1111/pedi.12139
    1. Deda L, Sochett EB, Mahmud FH. Physiological changes in blood pressure impact peripheral endothelial function during adolescence. Cardiol Young 2015;25:777–9. 10.1017/S1047951114001024
    1. Goldstein BH, Urbina EM, Khoury PR, et al. . Endothelial function and arterial stiffness relate to functional outcomes in adolescent and young adult Fontan survivors. J Am Heart Assoc 2016;5:e004258. 10.1161/JAHA.116.004258
    1. Goldstein BH, Gao Z, Khoury PR, et al. . Natural history of vascular function in adolescent and young adult Fontan survivors: a longitudinal assessment of endothelial function and arterial stiffness. Circulation 2017;136. 10.1161/circ.136.suppl_1.17719
    1. Urback ALM AWS, Islam AH, Korczak DJ, et al. . Cerebrovascular reactivity is associated with peripheral endothelial function among adolescents. Biological Psychiatry 2016;79:112S.
    1. Chen Y, Osika W, Dangardt F, et al. . Impact of psychological health on peripheral endothelial function and the HPA-axis activity in healthy adolescents. Atherosclerosis 2017;261:131–7. 10.1016/j.atherosclerosis.2017.03.012
    1. Odanaka Y, Takitani K, Katayama H, et al. . Microvascular endothelial function in Japanese early adolescents. J Clin Biochem Nutr 2017;61:228–32. 10.3164/jcbn.17-58
    1. Wahezi DM, Liebling EJ, Choi J, et al. . Assessment of traditional and non-traditional risk factors for premature atherosclerosis in children with juvenile dermatomyositis and pediatric controls. Pediatr Rheumatol Online J 2020;18:25. 10.1186/s12969-020-0415-5
    1. Zhang WY, Selamet Tierney ES, Chen AC, et al. . Vascular health of children conceived via In Vitro fertilization. J Pediatr 2019;214:47–53. 10.1016/j.jpeds.2019.07.033
    1. Mahtab S, Zar HJ, Ntusi NAB, et al. . Endothelial dysfunction in South African youth living with perinatally acquired human immunodeficiency virus on antiretroviral therapy. Clin Infect Dis 2020;71:e672–9. 10.1093/cid/ciaa396
    1. Bartz SKCMC, Krishnamurthy R, Bacha FF. Role of insulin resistance and hyperandrogenemia in early vascular dysfunction in adolescents with PCOS. Endocrine Reviews 2015;36.

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