Relationship of Circulating Endothelial Cells With Obesity and Cardiometabolic Risk Factors in Children and Adolescents

J Am Heart Assoc. 2021 Jan 5;10(1):e018092. doi: 10.1161/JAHA.120.018092. Epub 2020 Dec 29.


Background Circulating endothelial cells (CECs) reflect early changes in endothelial health; however, the degree to which CEC number and activation is related to adiposity and cardiovascular risk factors in youth is not well described. Methods and Results Youth in this study (N=271; aged 8-20 years) were classified into normal weight (body mass index [BMI] percentage <85th; n=114), obesity (BMI percentage ≥95th to <120% of the 95th; n=63), and severe obesity (BMI percentage ≥120% of the 95th; n=94) catagories. CEC enumeration was determined using immunohistochemical examination of buffy coat smears and activated CEC (percentage of vascular cell adhesion molecule-1 expression) was assessed using immunofluorescent staining. Cardiovascular risk factors included measures of body composition, blood pressure, glucose, insulin, lipid profile, C-reactive protein, leptin, adiponectin, oxidized low-density lipoprotein cholesterol, carotid artery intima-media thickness, and pulse wave velocity. Linear regression models examined associations between CEC number and activation with BMI and cardiovascular risk factors. CEC number did not differ among BMI classes (P>0.05). Youth with severe obesity had a higher degree of CEC activation compared with normal weight youth (8.3%; 95% CI, 1.1-15.6 [P=0.024]). Higher CEC number was associated with greater body fat percentage (0.02 per percentage; 95% CI, 0.00-0.03 [P=0.020]) and systolic blood pressure percentile (0.01 per percentage; 95% CI, 0.00-0.01 [P=0.035]). Higher degree of CEC activation was associated with greater visceral adipose tissue (5.7% per kg; 95% CI, 0.4-10.9 [P=0.034]) and non-high-density lipoprotein cholesterol (0.11% per mg/dL; 95% CI, 0.01-0.21 [P=0.039]). Conclusions Methods of CEC quantification are associated with adiposity and cardiometabolic risk factors and may potentially reflect accelerated atherosclerosis as early as childhood.

Keywords: adolescents; cardiovascular risk; children; endothelial health; novel biomarkers; obesity.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adiposity / physiology
  • Adolescent
  • Age of Onset
  • Atherosclerosis* / blood
  • Atherosclerosis* / diagnosis
  • Atherosclerosis* / physiopathology
  • Biomarkers / blood
  • Body Mass Index
  • Cardiometabolic Risk Factors
  • Cardiovascular Diseases* / epidemiology
  • Cardiovascular Diseases* / metabolism
  • Cardiovascular Diseases* / prevention & control
  • Child
  • Correlation of Data
  • Endothelial Cells / metabolism*
  • Female
  • Humans
  • Immunohistochemistry
  • Intra-Abdominal Fat / metabolism
  • Male
  • Obesity* / blood
  • Obesity* / diagnosis
  • United States / epidemiology
  • Vascular Cell Adhesion Molecule-1 / blood*


  • Biomarkers
  • Vascular Cell Adhesion Molecule-1