Ethnic cardiovascular disparities and lipidomic signatures in Chinese children: insights from a historical national survey and a contemporary regional cohort

Cardiovascular health disparities across ethnic groups have been well-documented in adults, but temporal patterns in children and underlying molecular mechanisms remain poorly understood. We analyzed two cohorts: the China Health and Nutrition Survey (CHNS, 1991-2015) with 8,062 children (13.7% minorities) and a contemporary regional Shimian County study (2021-2024) with 3,612 children (32.5% minorities, primarily Yi and Tibetan). We assessed blood pressure, anthropometrics, echocardiographic parameters, and sociodemographic factors. A nested case-control lipidomics study (n = 111) characterized ethnicity-specific molecular signatures. CHNS ethnic minority children demonstrated significantly lower odds of elevated blood pressure compared to Han Chinese (adjusted OR for elevated blood pressure: 0.85, 95% CI: 0.74-0.98, P = 0.028), with Han children exhibiting higher systolic blood pressure (98.3 ± 0.1 vs 97.1 ± 0.3 mmHg, P < 0.001). This association was not evident in the Shimian cohort (adjusted OR: 0.90, 95% CI: 0.76-1.07, P = 0.253). Cardiac structural analysis showed that left ventricular dimensions appeared larger in minority children. After body surface area indexing, ethnic differences in cardiac structure were largely attenuated, with systolic function preserved in both groups. Lipidomic profiling identified distinct ethnic-specific molecular signatures: Han children with hypertension showed diacylglycerol upregulation correlating with cardiac parameters (r = 0.45-0.62, P < 0.05), while in minority children triacylglycerol elevation and phosphatidylethanolamine reduction correlated with vascular function indices, though these associations were largely attenuated after adjustment for BMI z-score. Ethnic-specific lipidomic phenotypes may reflect distinct metabolic contexts of pediatric hypertension that warrant mechanistic and longitudinal investigation.