Samuel S Gidding

Publications (52)326.02 Total impact

• Article: Blood Pressure Screening in Children and Adolescents: Is the Glass Half Empty or More Than Half Full?

  Stephen R Daniels, Samuel S Gidding
  JAMA pediatrics. 01/2013;
• Article: Universal Screening of Cholesterol in Children.

  Peter O Kwiterovich, Samuel S Gidding
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  ABSTRACT: Atherosclerosis begins in childhood, and these early lesions are related to cardiovascular risk factors, including non-high-density lipoprotein cholesterol (HDL-C). Genetic disorders of lipid metabolism, principally familial hypercholesterolemia, have a high frequency in the population (about 1:300-1:500), and cause cardiovascular morbidity beginning in the third decade of life. The current obesity epidemic in children has worsened cardiovascular risk status. Cardiovascular risk factors present in youth often track into adulthood and are more predictive of future subclinical atherosclerosis than risk factors measured in young adulthood. Further, modification of risk factors beginning in childhood and young adulthood can lead to restoration to normal or improvement in measures of subclinical atherosclerosis measures both in those with genetic dyslipidemias and those with dyslipidemia secondary to obesity. Prior recommended selective lipid screening strategies based on family history or presence of other cardiovascular risk factors have failed to capture many with genetic dyslipidemia. Medium-term clinical trials of statin therapy for inherited dyslipidemias are safe and effective in lowering low-density lipoprotein cholesterol (LDL-C). Cholesterol screening in childhood is necessary to prevent cardiovascular morbidity in those with genetic dyslipidemias and to increase awareness of the need for behavioral intervention in those with multiple cardiovascular risk factors, often a result of the obesity epidemic. Peter O. Kwiterovich, MD has received a research grants from Pfizer and is on the advisory board at Merck. The authors have no other funding, financial relationships, or conflicts of interest to disclose.
  Clinical Cardiology 08/2012; · 2.15 Impact Factor
• Article: High Risk Blood Pressure and Obesity Increase the Risk for Left Ventricular Hypertrophy in African-American Adolescents.

  Bonita Falkner, Stephanie Deloach, Scott W Keith, Samuel S Gidding
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  ABSTRACT: OBJECTIVE: To examine the relative effects of high blood pressure (HBP) and obesity on left ventricular mass (LVM) among African-American adolescents; and if metabolic or inflammatory factors contribute to LVM. STUDY DESIGN: Using a 2 × 2 design, African-American adolescents were stratified by body mass index percentile (body mass index <95th percentile = non-obese; ≥95th percentile = obese) and average blood pressure (BP) (normal BP <120/80 mm Hg; HBP ≥120/80). Glucose, insulin, insulin resistance, lipids, and inflammatory cytokines were measured. From echocardiography measures of LVM, calculated LVM index (LVMI) ≥95th percentile defined left ventricular hypertrophy (LVH). RESULTS: Data included 301 adolescents (48% female), mean age 16.2 years, 51% obese, and 29% HBP. LVMI was highest among adolescents with both obesity and HBP. The multiplicative interaction of obesity and HBP on LVH was not significant (OR = 2.35, P = .20) but the independent additive associations of obesity and HBP with log-odds of LVH were significant; obesity OR = 3.26, P < .001; HBP OR = 2.92, P < .001. Metabolic and inflammatory risk factors were associated with obesity, but had no independent association with LVMI. Compared with those with average systolic BP (SBP) <75th percentile, adolescents with SBP from the 75th percentile to 90th percentile had higher LVMI (33.2 vs 38.7 g/m(2.7), P < .001) and greater LVH (18% vs 43%, P < .001), independent of obesity. CONCLUSIONS: Prevalence of LVH is highest among African-American adolescents with average BP ≥120/80 mm Hg and obesity. There also is an independent association of LVMI with BP, beginning at the 75th SBP percentile.
  The Journal of pediatrics 07/2012; · 4.02 Impact Factor
• Article: Childhood physical, environmental, and genetic predictors of adult hypertension: the cardiovascular risk in young Finns study.

  Jonna Juhola, Mervi Oikonen, Costan G Magnussen, Vera Mikkilä, Niina Siitonen, Eero Jokinen, Tomi Laitinen, Peter Würtz, Samuel S Gidding, Leena Taittonen, Ilkka Seppälä, Antti Jula, Mika Kähönen, Nina Hutri-Kähönen, Terho Lehtimäki, Jorma S A Viikari, Markus Juonala, Olli T Raitakari
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  ABSTRACT: Hypertension is a major modifiable cardiovascular risk factor. The present longitudinal study aimed to examine the best combination of childhood physical and environmental factors to predict adult hypertension and furthermore whether newly identified genetic variants for blood pressure increase the prediction of adult hypertension. The study cohort included 2625 individuals from the Cardiovascular Risk in Young Finns Study who were followed up for 21 to 27 years since baseline (1980; age, 3-18 years). In addition to dietary factors and biomarkers related to blood pressure, we examined whether a genetic risk score based on 29 newly identified single-nucleotide polymorphisms enhances the prediction of adult hypertension. Hypertension in adulthood was defined as systolic blood pressure ≥ 130 mm Hg and/or diastolic blood pressure ≥ 85 mm Hg or medication for the condition. Independent childhood risk factors for adult hypertension included the individual's own blood pressure (P<0.0001), parental hypertension (P<0.0001), childhood overweight/obesity (P=0.005), low parental occupational status (P=0.003), and high genetic risk score (P<0.0001). Risk assessment based on childhood overweight/obesity status, parental hypertension, and parental occupational status was superior in predicting hypertension compared with the approach using only data on childhood blood pressure levels (C statistics, 0.718 versus 0.733; P=0.0007). Inclusion of both parental hypertension history and data on novel genetic variants for hypertension further improved the C statistics (0.742; P=0.015). Prediction of adult hypertension was enhanced by taking into account known physical and environmental childhood risk factors, family history of hypertension, and novel genetic variants. A multifactorial approach may be useful in identifying children at high risk for adult hypertension.
  Circulation 06/2012; 126(4):402-9. · 14.74 Impact Factor
• Article: Developing the 2011 Integrated Pediatric Guidelines for Cardiovascular Risk Reduction.

  Samuel S Gidding, Stephen R Daniels, Rae Ellen W Kavey
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  ABSTRACT: This article reviews aspects of development of the recently released "Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents" for pediatric care providers that remain in the area of human judgment. Discussed will be the context in which the guidelines were developed, the formal evidence review process, a consideration of how quality grades were established, key social/ethical issues that the panel confronted, and a critique of the final work with recommendations for future guideline development. Lessons learned are that both a formal evidence review process is essential to developing a credible document, and human judgment is critical to producing a meaningful result. Guideline development is a dynamic process that must be continuously self-critical as new evidence is acquired and sociopolitical and environmental contexts evolve.
  PEDIATRICS 04/2012; 129(5):e1311-9. · 4.47 Impact Factor
• Article: Reply.

  Chaoyang Li, Earl S Ford, Samuel S Gidding
  The Journal of pediatrics 12/2011; 160(3):532. · 4.02 Impact Factor
• Article: Nontraditional risk factors and biomarkers for cardiovascular disease: mechanistic, research, and clinical considerations for youth: a scientific statement from the American Heart Association.

  Prabhakaran Babu Balagopal, Sarah D de Ferranti, Stephen Cook, Stephen R Daniels, Samuel S Gidding, Laura L Hayman, Brian W McCrindle, Michele L Mietus-Snyder, Julia Steinberger
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  ABSTRACT: The rapid increase in the prevalence and severity of obesity in children is likely to lower the age of onset and increase the incidence of cardiovascular disease worldwide. Understanding the pathophysiology and improving the clinical management of cardiovascular disease involve a knowledge of novel risk factors and biomarkers. The clinical and mechanistic roles of these novel biological factors during childhood are currently being investigated. The goals of this scientific statement are to present the existing knowledge and theoretical framework of nontraditional risk factors for cardiovascular disease as they relate to children and adolescents, to describe the relevance and weight of available experimental and clinical evidence and the therapeutic implications pertaining to nontraditional risk factors in the pediatric population, and to stimulate further research with a goal of developing valid and reliable approaches to identify and validate novel risk factors that will aid in the clinical evaluation and perhaps prediction of cardiovascular disease in the pediatric population. Although several biomarkers are promising, substantial research is required before nontraditional risk factors can be used to identify and reduce cardiovascular disease risk in children and adolescents.
  Circulation 06/2011; 123(23):2749-69. · 14.74 Impact Factor
• Source

  Available from: lipid.org

  Article: Pediatric aspects of familial hypercholesterolemias: recommendations from the National Lipid Association Expert Panel on Familial Hypercholesterolemia.

  Stephen R Daniels, Samuel S Gidding, Sarah D de Ferranti
  Journal of Clinical Lipidology 06/2011; 5(3 Suppl):S30-7. · 1.58 Impact Factor
• Article: Familial hypercholesterolemia: screening, diagnosis and management of pediatric and adult patients: clinical guidance from the National Lipid Association Expert Panel on Familial Hypercholesterolemia.

  Anne C Goldberg, Paul N Hopkins, Peter P Toth, Christie M Ballantyne, Daniel J Rader, Jennifer G Robinson, Stephen R Daniels, Samuel S Gidding, Sarah D de Ferranti, Matthew K Ito, Mary P McGowan, Patrick M Moriarty, William C Cromwell, Joyce L Ross, Paul E Ziajka
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  ABSTRACT: The familial hypercholesterolemias (FH) are a group of genetic defects resulting in severe elevations of blood cholesterol levels and increased risk of premature coronary heart disease. FH is among the most commonly occurring congenital metabolic disorders. FH is a treatable disease. Aggressive lipid lowering is necessary to achieve the target LDL cholesterol reduction of at least 50% or more. Even greater target LDL cholesterol reductions may be necessary for FH patients who have other CHD risk factors. Despite the prevalence of this disease and the availability of effective treatment options, FH is both underdiagnosed and undertreated, particularly among children. Deficiencies in the diagnosis and treatment of FH indicate the need for greatly increased awareness and understanding of this disease, both on the part of the public and of healthcare practitioners. This document provides recommendations for the screening, diagnosis and treatment of FH in pediatric and adult patients developed by the National Lipid Association Expert Panel on Familial Hypercholesterolemia. This report goes beyond previously published guidelines by providing specific clinical guidance for the primary care clinician and lipid specialist with the goal of improving care of patients with FH and reducing their elevated risk for CHD.
  Journal of Clinical Lipidology 06/2011; 5(3 Suppl):S1-8. · 1.58 Impact Factor
• Source

  Available from: PubMed Central

  Article: Serum non-high-density lipoprotein cholesterol concentration and risk of death from cardiovascular diseases among U.S. adults with diagnosed diabetes: the Third National Health and Nutrition Examination Survey linked mortality study.

  Chaoyang Li, Earl S Ford, James Tsai, Guixiang Zhao, Lina S Balluz, Samuel S Gidding
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  ABSTRACT: Non-high-density lipoprotein cholesterol (non-HDL-C) measures all atherogenic apolipoprotein B-containing lipoproteins and predicts risk of cardiovascular diseases (CVD). The association of non-HDL-C with risk of death from CVD in diabetes is not well understood. This study assessed the hypothesis that, among adults with diabetes, non-HDL-C may be related to the risk of death from CVD. We analyzed data from 1,122 adults aged 20 years and older with diagnosed diabetes who participated in the Third National Health and Nutrition Examination Survey linked mortality study (299 deaths from CVD according to underlying cause of death; median follow-up length, 12.4 years). Compared to participants with serum non-HDL-C concentrations of 35 to 129 mg/dL, those with higher serum levels had a higher risk of death from total CVD: the RRs were 1.34 (95% CI: 0.75-2.39) and 2.25 (95% CI: 1.30-3.91) for non-HDL-C concentrations of 130-189 mg/dL and 190-403 mg/dL, respectively (P = 0.003 for linear trend) after adjustment for demographic characteristics and selected risk factors. In subgroup analyses, significant linear trends were identified for the risk of death from ischemic heart disease: the RRs were 1.59 (95% CI: 0.76-3.32) and 2.50 (95% CI: 1.28-4.89) (P = 0.006 for linear trend), and stroke: the RRs were 3.37 (95% CI: 0.95-11.90) and 5.81 (95% CI: 1.96-17.25) (P = 0.001 for linear trend). In diabetics, higher serum non-HDL-C concentrations were significantly associated with increased risk of death from CVD. Our prospective data support the notion that reducing serum non-HDL-C concentrations may be beneficial in the prevention of excess death from CVD among affected adults.
  Cardiovascular Diabetology 05/2011; 10:46. · 3.35 Impact Factor
• Article: Non-high-density lipoprotein cholesterol concentration is associated with the metabolic syndrome among US youth aged 12-19 years.

  Chaoyang Li, Earl S Ford, Patrick E McBride, Peter O Kwiterovich, Brian W McCrindle, Samuel S Gidding
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  ABSTRACT: To test the hypothesis that the concentration of non-high-density lipoprotein cholesterol (non-HDL-C) is associated with the metabolic syndrome (MetS) in youth. Data on children and adolescents aged 12-19 years (n = 2734) from the cross-sectional National Health and Nutrition Examination Survey 1999-2004 were analyzed. Depending on the definition of MetS used, the mean non-HDL-C concentration among youth with MetS ranged from 144.2 to 155.8 mg/dL, compared with 108.8-109.1 mg/dL in those without MetS (all P < .001). The MetS prevalence ranged from 6.9% to 11.7% in youth with a non-HDL-C concentration of 120-144 mg/dL and from 21.5% to 23.4% in those with a concentration ≥ 145 mg/dL-both significantly higher than the prevalence of 1.9%-3.4% in youth with a concentration <120 mg/dL (all P < .001). After adjustment for potential confounders, youth with a non-HDL-C concentration ≥ 120 mg/dL or ≥ 145 mg/dL were about 3 or 4 times more likely to have MetS compared with those with a non-HDL-C <120 mg/dL or <145 mg/dL (all P < .001). Fasting non-HDL-C concentration was strongly associated with MetS in US youth. Our results support the use of non-HDL-C thresholds of 120 mg/dL and 145 mg/dL to indicate borderline and high MetS risk, respectively.
  The Journal of pediatrics 02/2011; 158(2):201-7. · 4.02 Impact Factor
• Source

  Available from: jefferson.edu

  Article: The challenge of communicating cardiovascular risk information to our patients.

  Samuel S Gidding
  The Journal of pediatrics 01/2011; 158(4):527-8. · 4.02 Impact Factor
• Article: Changes in circulating satiety hormones in obese children: a randomized controlled physical activity-based intervention study.

  Prabhakaran Babu Balagopal, Samuel S Gidding, Lisa M Buckloh, Hossein N Yarandi, James E Sylvester, Donald E George, Vicky L Funanage
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  ABSTRACT: The aims of this study are to examine in children: (i) obesity-related alterations in satiety factors such as leptin, ghrelin, and obestatin; (ii) the link between satiety factors and cardiometabolic risk factors; and (iii) the impact of a physical activity-based lifestyle intervention on the levels of these satiety factors in the obese. We studied a total of 21 adolescents (BMI percentile, 99.0 +/- 0.6 for 15 obese and 56.2 +/- 1.1 for 6 lean). The obese subjects underwent a 3-month randomized controlled physical activity-based lifestyle intervention. Leptin, soluble leptin receptor (sOB-R), ghrelin, and obestatin levels were determined as the primary outcome measures. Other markers of cardiometabolic disease such as inflammation and insulin resistance were also determined. Body composition was measured by dual-energy X-ray absorptiometry. The concentrations of ghrelin, obestatin, and sOB-R were significantly lower in the obese children compared to the lean controls, whereas that of leptin was higher (all P < 0.05). Although intervention led to a net increase in obestatin (P < 0.01) and no change in ghrelin levels, the balance between ghrelin and obestatin (ratio of ghrelin to obestatin, G/O) decreased (P < 0.02). Intervention reduced leptin and increased sOB-R (P < 0.01 for both). Significant associations between satiety factors and other cardiometabolic risk factors were also observed. Taken together, alterations in the levels of satiety factors are evident early in the clinical course of obesity, but physical activity-based lifestyle intervention either prevented their continued increase or normalized their levels. These beneficial effects appear to aid in the maintenance of body weight and reduction in cardiovascular risk.
  Obesity 09/2010; 18(9):1747-53. · 4.28 Impact Factor
• Article: Low cardiovascular risk is associated with favorable left ventricular mass, left ventricular relative wall thickness, and left atrial size: the CARDIA study.

  Samuel S Gidding, Mercedes R Carnethon, Stephen Daniels, Kiang Liu, David R Jacobs, Steve Sidney, Julius Gardin
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  ABSTRACT: Echocardiographic measures of left ventricular (LV) mass and relative wall thickness and left atrial (LA) size predict future cardiovascular morbidity and mortality. The aim of this study was to compare young adults with low cardiovascular risk (body mass index, 18.5-24.9 kg/m(2); blood pressure < 120/80 mmHg; no tobacco use, no diabetes, and physical fitness) with those without these characteristics with regard to LV mass and relative wall thickness and LA size, to determine the protective effect of a healthy lifestyle on the development of these characteristics. Cross-sectional assessment of 4059 black and white men and women aged 23 to 35 years in the Coronary Artery Risk Development in Young Adults (CARDIA) study at the year 5-examination, when risk factors were measured, and echocardiography to assess LV mass and relative wall thickness were performed. Physical fitness was measured at baseline using a symptom-limited maximal treadmill test. All other covariates were measured concurrently with echocardiography. Gender, body mass index, and systolic blood pressure were associated with LV mass and relative wall thickness and LA size in multivariate models. Additional correlates of LV mass/height(2.7) ratio were tobacco use, resting heart rate (inverse), self-reported physical activity, gender (male higher), and age. Age was associated with LV relative wall thickness but not other measures of LV size. Additional correlates of LA diameter/height ratio were tobacco use, resting heart rate (inverse), serum glucose, and self-reported physical activity. Seven hundred ninety of 4059 subjects (19%) were classified as having low risk; black race was less likely in the low-risk group. Those with low risk had lower LV mass/height(2.7) ratios (32.0 vs 34.6 g/m(2.7), P < .0001), better LV relative wall thickness (0.33 vs 0.35, P < .0001), and lower LA diameter/height ratios (2.02 vs 2.08 cm/m, P < .01). A low cardiovascular risk profile in young adulthood is associated with more favorable LV mass, LV relative wall thickness, and LA size. This may be one mechanism of lifestyle protection against cardiovascular morbidity and mortality.
  Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 08/2010; 23(8):816-22. · 2.98 Impact Factor
• Article: Echocardiography: an important tool for cardiovascular risk assessment.

  Samuel S Gidding
  Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 04/2010; 23(4):414-5. · 2.98 Impact Factor
• Article: Report of the National Heart, Lung, and Blood Institute's Working Group on obesity and other cardiovascular risk factors in congenital heart disease.

  Victoria L Pemberton, Brian W McCrindle, Shari Barkin, Stephen R Daniels, Sarah E Barlow, Helen J Binns, Meryl S Cohen, Christina Economos, Myles S Faith, Samuel S Gidding, Caren S Goldberg, Rae-Ellen Kavey, Patricia Longmuir, Albert P Rocchini, Linda Van Horn, Jonathan R Kaltman
  Circulation 03/2010; 121(9):1153-9. · 14.74 Impact Factor
• Source

  Available from: jefferson.edu

  Article: Familial hypercholesterolemia: a decade of progress.

  Samuel S Gidding
  The Journal of pediatrics 02/2010; 156(2):176-7. · 4.02 Impact Factor
• Source

  Available from: Laurie Whitsel

  Article: Implementing American Heart Association pediatric and adult nutrition guidelines: a scientific statement from the American Heart Association Nutrition Committee of the Council on Nutrition, Physical Activity and Metabolism, Council on Cardiovascular Disease in the Young, Council on Arteriosclerosis, Thrombosis and Vascular Biology, Council on Cardiovascular Nursing, Council on Epidemiology and Prevention, and Council for High Blood Pressure Research.

  Samuel S Gidding, Alice H Lichtenstein, Myles S Faith, Allison Karpyn, Julie A Mennella, Barry Popkin, Jonelle Rowe, Linda Van Horn, Laurie Whitsel
  Circulation 04/2009; 119(8):1161-75. · 14.74 Impact Factor
• Article: Are pediatricians responsible for prevention of adult cardiovascular disease?

  Henry C McGill, C Alex McMahan, Samuel S Gidding
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  ABSTRACT: Atherosclerosis begins in childhood with fatty streaks, which progress seamlessly to fibrous plaques in adulthood. These plaques, in turn, might rupture and cause thrombotic arterial occlusion and ischemic damage to vital organs. The earliest stages and progression of atherosclerosis in youth are influenced by the same major established risk factors for this condition in adults-dyslipidemia, hypertension, smoking, obesity, and diabetes mellitus. Controlling these risk factors at any age is beneficial, but the earlier primary prevention begins, the better the result. As recommended by the American Academy of Pediatrics, pediatricians should support both control and prevention of these risk factors in children via lifestyle modification. Drug treatment can be used to supplement lifestyle modification in the few cases of children with genetic dyslipidemias who do not respond to diet changes. Ultimately, however, effective prevention of adult disease requires a massive cultural change.
  Nature Clinical Practice Cardiovascular Medicine 11/2008; 6(1):10-1. · 7.04 Impact Factor
• Article: Blood pressure variability and classification of prehypertension and hypertension in adolescence.

  Bonita Falkner, Samuel S Gidding, Ronald Portman, Bernard Rosner
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  ABSTRACT: There is little information in pediatrics on the persistence of the prehypertension and hypertension classifications or on the progression of prehypertension to hypertension. This study aimed to examine those issues. An analysis of data from the National Childhood Blood Pressure database was conducted to examine the longitudinal blood pressure outcomes for adolescents classified after a single measurement of blood pressure. Adolescent subjects (N = 8535) for whom serial single blood pressure measurements were obtained at intervals of 2 years were identified. Subjects were stratified according to blood pressure status at the initial measurement, as having normotension, prehypertension, or hypertension. Among subjects designated as having prehypertension (n = 1470), 14% of boys and 12% of girls had hypertension 2 years later. Among subjects designated as having hypertension, 31% of boys and 26% of girls continued to exhibit hypertension, and 47% of boys and 26% of girls had blood pressure values in the prehypertensive range. Regression models showed no significant effect of race on blood pressure changes but significant effects of initial BMI and changes in BMI. These data indicated that the rate of progression of prehypertension to hypertension was approximately 7% per year. Prehypertension can be predictive of future hypertension and may benefit from preventive interventions, especially lifestyle changes.
  PEDIATRICS 09/2008; 122(2):238-42. · 4.47 Impact Factor