Review
Hypertension, Obesity, and Coronary Artery Disease in the Survivors of Congenital Heart Disease

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Abstract

Obesity, hypertension, and coronary artery disease are prevalent in the general population and well recognized as contributors to cardiac morbidity and mortality. With surgical and medical advances, there is a growing and aging population with congenital heart disease who are also at risk of developing these comorbidities. In addition, some congenital cardiac lesions predispose patients to conditions such as hypertension or coronary artery disease. The effect of these comorbidities on the structurally abnormal heart is not well understood, but might be very important, especially in those with residual abnormalities. Thus, in addition to surveillance for and treatment of late complications it is important for the congenital cardiologist to consider and aggressively manage acquired comorbidities. In this review we explore the prevalence of hypertension, obesity, and coronary artery disease, discuss congenital lesions that predispose to these conditions and review management strategies for this unique population.

Résumé

L’obésité, l’hypertension et la coronaropathie sont répandues dans la population générale et bien connues comme étant des facteurs contribuant à la morbidité et à la mortalité cardiaques. Grâce aux avancées chirurgicales et médicales, une population de plus en plus grande et vieillissante ayant une cardiopathie congénitale est également exposée à un risque de développer ces comorbidités. De plus, certaines lésions cardiaques congénitales prédisposent les patients à des affections comme l’hypertension ou la coronaropathie. L’effet de ces comorbidités sur le cœur structurellement anormal n’est pas bien compris, mais pourrait être très important, particulièrement chez ceux ayant des anomalies résiduelles. Par conséquent, en plus de la surveillance et du traitement des complications tardives, il est important pour le cardiologue spécialisé en cardiopathie congénitale de considérer et de prendre en charge de façon vigoureuse les comorbidités acquises. Dans cette revue, nous explorons la prévalence de l’hypertension, de l’obésité et de la coronaropathie, discutons des lésions congénitales qui prédisposent à ces affections, et passons en revue les stratégies de prise en charge de cette population propre.

Section snippets

Hypertension

Hypertension is a complex condition with a pathophysiology related to detrimental biochemical signalling pathways and widespread cardiovascular and renal abnormalities. Environmental interactions are also important contributors. The long-term effects of hypertension are serious; in the heart it can lead to premature CAD, ventricular hypertrophy, impaired ventricular relaxation, and cardiac arrhythmia, any of which could be important for a patient already burdened with CHD. Outside of the heart,

Obesity

Worldwide there is increasing concern about obesity. Internationally agreed definitions for adults with excessive accumulation of body fat categorize “overweight” as a body mass index (BMI) of 25-30 and “obesity” as BMI ≥ 30. In 2008, 62.1% of Canadian adults were either overweight or obese.30 Definitions in childhood are more complex because body weight composition varies considerably with age, sex, and pubertal stage. The 2009-2011 Canadian Health Measures Survey applied World Health

CAD

In the general population, the prevalence of CAD increases with age66 and is strongly associated with the presence of risk factors such as dyslipidemia, hypertension, diabetes, smoking, and obesity.67 With an aging ACHD cohort similarly exposed to CAD risk factors,6, 32 we can expect increasing numbers of ACHD patients with concomitant CAD. Opotowsky et al. reported increasing admissions between 1998 and 2005 for CAD in ACHD patients.68 Afilalo et al. reported a 10% prevalence of CAD in ACHD

Conclusion

Given access to surgical repair, most infants born with CHD survive but it is increasingly understood that they are not “cured.” Along with the rest of the population, these patients (some with significant residual hemodynamic and electrical abnormalities) run the gauntlet of cardiovascular challenges posed by our modern lifestyles. Individuals with CHD who develop the pathophysiologically linked95 conditions of hypertension, obesity, or atherosclerosis significantly increase their

Funding Sources

Dr Silversides is supported by Operating Grants from Canadian Institutes of Health Research.

Disclosures

The authors have no conflicts of interest to disclose.

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