Large-artery vascular remodeling, such as arterial stiffening and dilation, is a biophysical antecedent to hypertension in adults. Emerging data in children identifies vascular remodeling as a feature of obesity, which is associated with present and future hypertension. Dr. Zachariah's research project examines the central hypothesis that excess weight in adolescents is related to vascular remodeling by assessing cross-sectional correlation as well as longitudinal change after weight loss. Using a combined tonometry-echocardiography system, Specific Aim 1 explores the hypothesis that excess weight will be associated with higher conduit arterial stiffness as indexed by central pulse pressure (PP), forward pulse wave (FPW), characteristic impedance (Zc) and carotid femoral pulse wave velocity (CFPWV), as well as with arterial dilation as indexed by larger effective aortic diameter (Da). Peripheral resistance (Zo) will be lower leading to higher pulse wave reflection as indexed by global reflection coefficient (RC). Secondary hypotheses include that a) the majority of the variation in central PP will be due to FPW, and b) the association between excess weight and vascular remodeling will be attenuated by circulating markers of insulin resistance, leptin resistance, inflammation, and aldosterone-to-renin ratio.
Specific Aim 2 examines the effect of 2 months of weight loss on arterial stiffness and pulsatile load in 54 excess weight adolescents 13-18 attending a summer weight loss camp The educational component of this K23 award will include hands-on training in vascular testing and didactic course- work in analysis of biomarkers, analysis of multiple biomarker """"""""-omic"""""""" platforms, and clinical trials. Mentorship will come from Drs. Jane Newburger, Vasan Ramachandran, and Gary Mitchell who have specific expertise in pediatric cardiovascular disease (CVD), adult CVD, circulating biomarkers in CVD, and vascular phenotypes in CVD. Enhanced by support from the NIH-sponsored Harvard Catalyst Clinical Translational Science Unit and the Department of Cardiology, the proposed K23 award will provide structured mentorship, protected research time, and training in modular, broadly applicable cardiovascular research techniques. The award will position Dr. Zachariah to be one of the few independently-funded pediatric cardiology clinical researchers in the country studying vascular medicine in high-risk children.

Public Health Relevance

(RELEVANCE): Identifying biophysical and biochemical correlates of vascular remodeling may facilitate risk stratification for CVD in children, indicate candidate biological pathways involved early in vascular remodeling, and suggest specific targets for intervention.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZHL1-CSR-X (M1))
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Scott, Jane
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Children's Hospital Boston
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Twichell, Sarah A; Rea, Corinna J; Melvin, Patrice et al. (2017) The effect of an electronic health record-based tool on abnormal pediatric blood pressure recognition. Congenit Heart Dis 12:484-490
Johnson, Philip K; Mendelson, Michael M; Baker, Annette et al. (2017) Statin-Associated Myopathy in a Pediatric Preventive Cardiology Practice. J Pediatr 185:94-98.e1
Zachariah, Justin P (2017) Pulse wave reflection in children: amplification through the lifecourse. J Hypertens 35:1363-1365
Joyce, Nina R; Zachariah, Justin P; Eaton, Charles B et al. (2017) Statin Use and the Risk of Type 2 Diabetes Mellitus in Children and Adolescents. Acad Pediatr 17:515-522
Zachariah, Justin P (2017) Alcohol Consumption Patterns and Vascular Properties: The Value of Repeatedly Measured Longitudinal Data. J Am Heart Assoc 6:
Steinberger, Julia; Daniels, Stephen R; Hagberg, Nancy et al. (2016) Cardiovascular Health Promotion in Children: Challenges and Opportunities for 2020 and Beyond: A Scientific Statement From the American Heart Association. Circulation 134:e236-55
Zachariah, Justin P; Hwang, Susan; Hamburg, Naomi M et al. (2016) Circulating Adipokines and Vascular Function: Cross-Sectional Associations in a Community-Based Cohort. Hypertension 67:294-300
Zachariah, Justin P; Johnson, Philip K; Colan, Steven D (2016) Aortic Stiffness in Youth with Hypertrophic Cardiomyopathy Genotype. Pediatr Cardiol 37:932-7
Mendelson, Michael M; Regh, Todd; Chan, James et al. (2016) Correlates of Achieving Statin Therapy Goals in Children and Adolescents with Dyslipidemia. J Pediatr 178:149-155.e9
Zachariah, Justin P; Chan, James; Mendelson, Michael M et al. (2016) Adolescent Dyslipidemia and Standardized Lifestyle Modification: Benchmarking Real-World Practice. J Am Coll Cardiol 68:2122-2123

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