**10. Future perspectives**

Despite numerous investigations and several cardiovascular risk factors evaluation, we still do not have a marker or investigation with prognostic value that would predict future CVD and premature cardiovascular events in children at risk. Several new biomarkers and investigations are emerging in research environment to assess cardiovascular risk, such as kidney injury molecule 1, adropin, salusin-α and -ß, uromodulin, markers of oxidative stress, along with functional diagnostics such as body composition measurement and elastography. Kidney injury molecule 1, a known marker for kidney tubular necrosis, was found elevated in overweight children [49]. Salusin-α and -ß are involved directly in the process of atherosclerosis with salusin-α slowing down and salusin-ß promoting atherosclerosis. In children, salusin-α correlated negatively with diastolic pressure [50, 51]. Adropin was discovered recently as a regulator of endothelial function among its several other physiological roles, such as angiogenesis, metabolism of glucose, fatty acids and dyslipidemia. Its role is protective and in overweight children lowered levels were found [52]. Uromodulin has an immunomodulatory role. In urine, it serves as a marker of kidney damage, however, in blood serum in elderly it was found to be a marker in CVD prognosis [53]. Children with diabetes had lower levels of serum uromodulin that correlated negatively with albuminuria [54]. Atherosclerosis, nowadays considered a chronic inflammatory process, is also being extensively researched through inflammatory markers and markers of oxidative stress, and some association with overweight in children has already been shown [55]. Very recently, microRNA is emerging as another possible diagnostic or therapeutic target that is being increasingly studied. Its postranslational function involves role in lipid metabolism, however, additional research, especially in children, is warranted [56], as for all other above mentioned biomarkers.

Along with fat mass evaluation, discussed in the second section, ultrasound and magnetic elastography are emerging as novel techniques for organ elasticity

### *Cardiovascular Risk Factors in Children DOI: http://dx.doi.org/10.5772/intechopen.99729*

determination. The use of ultrasound elastography opens up a new spectrum of ultrasound applications - its use has spread in liver and tumor stiffness evaluation, and several new indications are emerging in the research environment [57]. In the context of cardiovascular risk assessment, liver elasticity could be evaluated in obesity to assess the degree of steatosis or fibrosis without invasive liver biopsy [58]. Ultrasound elastography might also non-invasively assess elastic properties of the kidney aiming to quantify intrarenal fibrosis that could contribute to the overall assessment of renal function [59]. In children, liver elastography has been successfully performed, however, other areas remain a subject of research. The predictive value of elastography in the context of cardiovascular risk has yet to be determined.

Cardiovascular risk factors are strongly affected by environmental factors and unhealthy lifestyle choices. However, some susceptibility is inherited and related to the cumulative effect of many common genetic variants. With the progress of genetic diagnostics, made in recent years, there is also a place for the research of genetic susceptibility and the role of genetic markers and their possible implementation in clinical praxis. Genome-wide association studies have been successful in identifying some associations of single nucleotide polymorphisms for coronary artery disease. It has been shown that some of the manifestations of coronary heart disease, such as calcification, ectasia and main-stem stenosis, are more strongly inherited than others. The results of genome-wide association studies are believed to aid in individual risk prediction for cardiovascular risk and events development by molecular biological methods [60, 61].
