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BACKGROUND Adiponectin, an adipocytokine with beneficial biological functions relevant to cardiovascular (CV) diseases, and arterial stiffness, an indicator of vascular function, are considered to be important correlates of CV disease risk. Although racial (black-white) divergences in adiponectin and arterial stiffness are known, information is scant regarding the association between these two parameters among asymptomatic young adults within each race. METHODS As part of the Bogalusa Heart Study, arterial stiffness was examined noninvasively in terms of aorta-femoral pulse wave velocity (af-PWV) in 991 black and white nondiabetic subjects (72% white, 43% male) aged 24-44 years. RESULTS In a multivariate regression model by race that included adiponectin, age, sex, waist circumference, mean arterial pressure, heart rate, homeostasis model assessment of insulin resistance, low- and high-density lipoprotein cholesterols, triglycerides, and cigarette smoking, the significant predictors of af-PWV, in the order of entry, were: mean arterial pressure, age, smoking, and heart rate in both races, followed by adiponectin (inverse relation) in blacks. Further, after adjusting for mean arterial pressure, age, smoking, and heart rate, the odds ratio of finding excess af-PWV (top decile vs. the rest) in individuals with low adiponectin levels (bottom quartile vs. the rest) was significantly higher in blacks (OR: 2.5; 95% CI: 1.1-5.5), but not in whites (OR: 0.9; 95% CI: 0.5-1.9). CONCLUSIONS These findings suggest that the status of hypoadiponectinemia is an independent correlate of excess arterial stiffness in asymptomatic young black adults.

To alter the adverse natural course of coronary artery disease and its risk factors, primary prevention should begin in childhood.High serum cholesterol, LDL cholesterol (LDL-C) in particular, remains the major determinant of atherosclerotic process beginning in childhood. Selective cholesterol screening of children based on family history is inadequate. Tracking of childhood elevated cholesterol in conjunction with other risk factors into adulthood argues in favor of universal screening in the young. Further, individual adverse levels of LDL-C not only increase the incidence of adulthood dyslipidemia, but also markedly enhances the prevalence of obesity and hypertension seen in the adult population.Screening of all young individuals for serum cholesterol along with a cardiovascular risk factor profile is recommended. Cardiovascular disease remains a public health issue and identifying young individuals at risk is basic to prevention.

The Bogalusa Heart Study, a long-term population study with a continued relationship with a community, addresses the problem of capacity building in minority health research. The study was originally funded as a Specialized Center of Research-Arteriosclerosis (SCOR-A) by the National Heart Lung and Blood Institute (NHLBI). These centers were to conduct research on atherosclerosis, coronary artery disease (CAD), hypertension, diabetes mellitus, and complications of cardiovascular-renal disease as the major causes of deaths in the United States. From earlier research on atherosclerosis, we became interested in the underlying characteristics in early life that would eventually lead to clinical morbidity and mortality from heart disease. An observation at autopsy showed the degree of atherosclerotic involvement in human aortas, from young to older individuals (Figure 1). For example, at age 40 years, marked individual variability occurred in the severity and involvement with atherosclerotic disease. Some individuals showed very little disease, while almost 70% of the surface was diseased in others. Further studies on arterial wall matrix showed aortas from young individuals varied with the extent of disease and its chemical composition. This background stimulated an interest in studying children for early clinical evidence of major adult heart diseases. The Bogalusa Heart Study was begun in 1972 as an epidemiology study of cardiovascular risk factors in children and adolescents; it eventually evolved into observations of young adults. Bogalusa, LA, is a biracial (black/white) rural community 70 miles north of New Orleans, comparable to many other communities in southeastern United States.

Although parent-offspring associations of cardiovascular risk factor variables are known, the age-specific nature of this familial relationship is not clear.This aspect was examined in 727 unrelated children (mean age: 11.2 years) and their parents who participated in the Bogalusa Heart Study during their childhood (mean age: 11.3 years) and adulthood (mean age: 25.5 years).After adjusting for covariates, the mothers' childhood-offspring correlations were consistently higher than mothers' adulthood-offspring correlations for body mass index (BMI) [r = 0.45 vs. 0.32], systolic blood pressure (SBP) [r = 0.30 vs. 0.10], diastolic blood pressure (DPB) [r = 0.22 vs. 0.13] and low-density lipoprotein cholesterol (LDLC) [r = 0.20 vs. 0.11]. In contrast, high-density lipoprotein cholesterol (HDLC) and triglycerides did not show such age-specific trends in mother-offspring correlations. Corresponding father-offspring correlations showed similar patterns, but the differences were of lesser magnitude. Multiple regression analyses using offspring's risk factor variables as dependent variables revealed that parents' childhood obesity, blood pressure and LDLC levels were better predictors of the corresponding variables in the young offspring than parents' adulthood values. Further, sex of either parents or offspring made no difference in the above findings.The magnitude of the familial associations of cardiovascular risk factor variables between parents and offspring are influenced by age. Intrinsic genetic make-up, duration of exposure to environment and gene-environment interactions may play a role in this association.

Elevated serum triglyceride level is increasingly being recognized as an important indicator of cardiovascular risk. The distribution and correlates of serum triglycerides were examined in a biracial (black-white) community-based sample of 1342 young adults (30% black) aged 20-37 years. Triglyceride levels showed significant race (whiteblack) and sex (malefemale) differences. Black females, despite their relatively increased body fatness, had lowest triglyceride levels. In terms of conjoint trait of dyslipidemia based on the National Cholesterol Education Program cutpoints, 9% of white males displayed high triglyceride (or =200 mg/dl) in combination with low high-density lipoprotein (HDL)-cholesterol (35 mg/dl). In comparison, none of the black females fell into this category. Serum triglycerides even at levels between 100 and 150 mg/dl were significantly adversely associated with risk variables of insulin resistance syndrome such as adiposity and visceral fatness measures, HDL-cholesterol, insulin, and systolic blood pressure, especially among whites. Visceral fatness as measured by waist circumference (except black males) and insulin were the major predictors of triglyceride levels. Overall, triglyceride levels above 150 mg/dl were associated with increased risk of hypertension (odds ratio (OR)=1.8, 95% confidence interval (CI)=1.8-3.0), type 2 diabetes (OR=3.1, CI=1.4-6.9), parental history of hypertension (OR=1.3, CI=1.0-1.8) and parental history of type 2 diabetes (OR=1.7, CI=1.2-2.3). Thus, serum triglyceride levels may be valuable in the assessment of cardiovascular risk during young adulthood.

It is well recognized that end-stage renal disease (ESRD) is associated with accelerated and malignant hypertension. The association of renal disease and what is considered as normal blood pressure is still not clear. The present study examined the temporal relation between blood pressure and renal function reflected by serum creatinine in a biracial (black-white) community-based population enrolled in the Bogalusa Heart Study. The study included 662 young adults aged 19 to 32 years, (white men, n = 188; white women, n = 289; black men, n = 67; and black women, n = 118) who were followed for an average of 7.4 years. In black men, partial correlation adjusted for age, body mass index, serum glucose, uric acid, and cigarette smoking showed that baseline systolic and diastolic blood pressure are not significantly related to baseline serum creatinine, but significantly related to serum creatinine at follow-up (r = 0.38, P = .008 and r = 0.42, P = .003, respectively). Multivariate regression analysis further showed a significant prediction of serum creatinine at follow-up by baseline systolic and diastolic blood pressure (0.031 mg/dL and 0.037 mg/dL rise in follow-up serum creatinine for every 10 mm Hg increase in systolic (P = .000) and diastolic (P = .001) blood pressure at baseline, but not the other way around. Other race and sex groups did not show such significant temporal relations. We conclude that in young black men, higher blood pressure levels within normal range precede and explain part of the increase in serum creatinine, a measure of decline in renal function. Thus, our results underscore the beneficial effect of maintaining blood pressure levels lower than what is considered as the upper normal limit, particularly in black men.

To evaluate the impact of breakfast consumption patterns on the nutritional adequacy of diets of young adults and determine possible ethnic and gender differences.Cross-sectional survey of young adults in Bogalusa, La.Twenty-four-hour dietary recalls were collected from October 1988 through October 1991 on 504 young adults (mean age=23 years, 58% women, 70% white).Analysis of variance and logistic regression techniques were used to investigate the relationship of breakfast consumption, ethnicity, and gender on dietary adequacy. The P values are from an analysis of variance model that adjusted for gender and ethnicity.Thirty-seven percent of young adults skipped breakfast. Of those who ate breakfast, 75% ate at home, 10% ate a fast-food breakfast, and 15% reported other sources. Mean energy intake from breakfast was 485 kcal; men consumed more energy than women (P.001), and blacks consumed more energy than whites (P.01). The breakfast meal provided an average of 13% of energy from protein, 55% from carbohydrate, 14% from sucrose, 34% from fat, and 12% from saturated fat. Whites consumed a breakfast higher in carbohydrate and sucrose than blacks, who consumed a breakfast higher in fat and saturated fat. Variations in breakfast foods consumed explained the racial differences in the nutrient composition of the breakfast meal. Young adults who skipped breakfast had lower total daily intakes of energy (P.0001), protein per 1,000 kcal (P.05), and saturated fat per 1,000 kcal (P.01) than those who consumed breakfast. For all vitamins and minerals studied, a higher percentage of young adults who skipped breakfast did not meet two thirds of the Recommended Dietary Allowance than those who consumed a breakfast.Encouraging consumption of breakfast, along with selection of more healthful breakfast food choices or snacks that are culturally appropriate, may be important strategies for improving the nutritional quality of young adults' diets.

In adults, cardiovascular risk factors reinforce each other in their effect on cardiovascular events. However, information is scant on the relation of multiple risk factors to the extent of asymptomatic atherosclerosis in young people.We performed autopsies on 204 young persons 2 to 39 years of age, who had died from various causes, principally trauma. Data on antemortem risk factors were available for 93 of these persons, who were the focus of this study. We correlated risk factors with the extent of atherosclerosis in the aorta and coronary arteries.The extent of fatty streaks and fibrous plaques in the aorta and coronary arteries increased with age. The association between fatty streaks and fibrous plaques was much stronger in the coronary arteries (r=0.60, P0.001) than in the aorta (r=0.23, P=0.03). Among the cardiovascular risk factors, body-mass index, systolic and diastolic blood pressure, and serum concentrations of total cholesterol, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol, as a group, were strongly associated with the extent of lesions in the aorta and coronary arteries (canonical correlation [a measure of the association between groups of variables]: r=0.70; P0.001). In addition, cigarette smoking increased the percentage of the intimal surface involved with fibrous plaques in the aorta (1.22 percent in smokers vs. 0.12 percent in nonsmokers, P=0.02) and fatty streaks in the coronary vessels (8.27 percent vs. 2.89 percent, P=0.04). The effect of multiple risk factors on the extent of atherosclerosis was quite evident. Subjects with 0, 1, 2, and 3 or 4 risk factors had, respectively, 19.1 percent, 30.3 percent, 37.9 percent, and 35.0 percent of the intimal surface covered with fatty streaks in the aorta (P for trend=0.01). The comparable figures for the coronary arteries were 1.3 percent, 2.5 percent, 7.9 percent, and 11.0 percent, respectively, for fatty streaks (P for trend=0.01) and 0.6 percent, 0.7 percent, 2.4 percent, and 7.2 percent for collagenous fibrous plaques (P for trend=0.003).These findings indicate that as the number of cardiovascular risk factors increases, so does the severity of asymptomatic coronary and aortic atherosclerosis in young people.

To examine community differences in cardiovascular disease (CVD) risk factors among black and white young adults by combining data from two large epidemiologic studies.Data are from participants aged 20-31 years in the Coronary Artery Risk Development In Young Adults (CARDIA) study (1987-1988; N = 4129) and the Bogalusa Heart study (1988-1991; N = 1884), adjusting for data collection differences prior to analysis. CARDIA includes four urban sites: Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; and Oakland, California. Bogalusa is a semi-rural town in Southeastern Louisiana. CVD risk factors examined were smoking status, body habitus, and blood pressure.In Birmingham and Bogalusa, more white than black women were current smokers; no ethnic differences were observed among men. In Chicago, Minneapolis, and Oakland, more blacks were current smokers than were whites. For all sites, educational level was strongly inversely related to current smoking status; ethnic differences were more apparent among those with up to a high school education. Among white men and women, prevalence of obesity (body mass index31.1 kg/m2 in men and 32.3 kg/m2 in women) was greater in Birmingham and Bogalusa than in Chicago. Minneapolis, and Oakland. Mean systolic blood pressures were highest in Bogalusa, and the proportion of black men with elevated blood pressure (or = 130/85 mmHg) was higher in Bogalusa and Birmingham.Community and ethnic differences in CVD risk factors were observed among young adults in two large epidemiologic studies. Further studies may enhance our understanding of the relationship of geographic differences in CVD risk to subsequent disease.

Although the association between parental coronary artery disease (CAD) and its risk factors in the offspring is known, the timing and the course of development of risk factors from childhood to adulthood in the offspring is not known.To examine the association between parental CAD and longitudinal changes in risk factor profile from childhood to young adulthood in offspring.Cohort study.Bogalusa, La, a semirural, biracial community.Individuals with clinically verified parental history of CAD (n=271) vs those without such a history (n = 1253) Mean age at first CAD event was 50 years for fathers and 52 years for mothers.Body mass index, subscapular skinfolds, blood pressure, and triglyceride, cholesterol (total, very low-density lipoprotein [VLDL-C], low-density lipoprotein [LDL-C], and high-density lipoprotein [HDL-C] cholesterols), glucose, and insulin levels.The offspring of parents with CAD were consistently overweight beginning in childhood. Their levels of total serum cholesterol, LDL-C, plasma glucose, and insulin became significantly higher at older ages, because of a higher rate of increase in these risk factors over time. In adulthood, the offspring with a positive parental history had a higher prevalence of obesity (body mass index85th percentile in the National Health and Nutrition Examination Survey I, 35% vs 26%, P=.01), elevated total cholesterol (6.2 mmol/L [240 mg/dL], 8.4% vs 4.8%, P=.05) and LDL-C levels (4.1 mmol/L [160 mg/dL], 12.4% vs 4.7%, P=.05), and hyperglycemia (glucose,6.6 mmol/L, 2.7% vs 0.4%, P.001), as well as a higher coexistence of these conditions (P=.01). Further, the prevalence of dyslipidemia, either involving only LDL-C or LDL-C in combination with HDL-C or triglycerides or both, was significantly higher in the adult offspring with parental CAD.Offspring of parents with early CAD were overweight beginning in childhood and developed an adverse cardiovascular risk factor profile at an increased rate. These observations have important implications for prevention and intervention.

To compare the body mass index (BMI) (weight/height2) and the Ponderal index (PI) (weight/height3) in childhood as predictors of adult overweight in a biracial group of children.Prospective, 15-y follow-up.835 children aged 10-15 y at baseline.Weight in kg and height in m.Overweight, defined as a BMI greater than 27 kg/m2 in young adults.Overall, the BMI and the PI at baseline were identically correlated with the BMI at follow-up (r = 0.64, p0.001). However, the predictions of overweight based on each index were distinctively affected by age, sex and race. The probability of adult overweight among 10-year old children was greater than 0.5 (50% overweight threshold) if their BMI exceeded 17 kg/m2 in black girls, 20 in white girls and 18 in boys of either race. Similarly, the 50% BMI overweight thresholds among 15-year-old children were 23 kg/m2 for black girls, 25 for white girls and 22 for boys of either race. The 50% PI overweight thresholds (in kg/m2) were 12 and 14 for 10-year-old black girls and white girls, respectively; and 14 and 16 for 15-year-old black girls and white girls, respectively. Among boys, the 50% PI threshold was 13 kg/m3 regardless of age or race.The BMI and the PI in childhood were both useful in assessing sex-and race-specific risks of adult overweight. However, assessments based on the Ponderal index were less affected by age and race than those based on the BMI, particularly among boys. Hence, to establish general weight goals for children, aimed at preventing adult obesity, the PI could be a much better choice than the BMI.

The use of fourth phase Korotkoff sound (K4) versus fifth phase Korotkoff sound (K5) for the determination of diastolic blood pressure (DBP) has been a subject of controversy since the indirect method of determining arterial blood pressure was described. Using data from the Bogalusa Heart Study, we evaluated the differences between K4 and K5 (K4-K5) from 4633 subjects 5 to 30 years of age examined between 1987 and 1991. The overall mean difference between K4 and K5 was 9.9 +/- 5.6 mm Hg (mean +/- SD). The average difference was highest in 5 to 8 year olds, where it measured 12.3 +/- 5.5 mm Hg. The average K4-K5 difference fell with increasing age and reached a value of 6.3 +/- 2.6 mm Hg by 25 years of age. For all race/sex groups, the youngest two age groups differed statistically from the oldest age groups in K4-K5 difference (P.006). There were significant differences between blacks and whites (P.015) and between men and women (P.001) for subjects between 13 and 17 years of age. Additional analyses were performed with individuals having K5 = 0 added to yield an expanded population of 5117 persons. Overall, 9.5% had at least one of six measurements of K5 = 0 and most were young subjects: 27% of children 5 to 8 years and 13% of children 9 to 12 years. We conclude that by age 15 there may be no relevant clinical difference in K4-K5. However, in children, K4 and K5 should be recorded and K4 is a more reproducible measure of diastolic blood pressure.

To document the contribution of meat consumption to the overall nutritional quality of the diet and assess its impact on cardiovascular risk factors in young adults.A cross-sectional survey of young adults in Bogalusa, La.We collected 24-hour dietary recalls from 504 19- to 28-year-olds from 1988 through 1991.We examined dietary composition by meat consumption quartiles. Analysis of variance and Newman-Keuls range tests were performed.Young adults consume an average of 6.5 oz meat daily; whites most often consumed beef and blacks most often consumed pork and poultry. Persons in the25th percentile for meat consumption consumed a diet closest to recommended levels--with 11% of energy from protein, 55% from carbohydrate, 32% from fat, 11% from saturated fatty acids, and 264 mg dietary cholesterol. In contrast, persons in the75th percentile for meat consumption consumed a diet with 18% of energy from protein, 40% from carbohydrate, 41% from fat, 13% from saturated fatty acids, and 372 mg dietary cholesterol. Intakes of heme iron and phosphorus were lower and calcium intake higher in persons in the25th percentile compared with those in the75th percentile for meat consumption. The percent of persons meeting two thirds of the Recommended Dietary Allowances for vitamin B-12, niacin, and zinc was greater in the75th percentile for meat consumption compared with the25th percentile for meat consumption. We noted no differences across meat consumption quartiles in blood lipids and lipoproteins, anthropometric measurements, and hemoglobin levels.Consumption of moderate amounts of lean meat, along with healthier choices in other food groups, may be necessary to meet the current dietary recommendations.

To determine dietary fiber intake of children and young adults.Cross-sectional surveys of children and young adults in Bogalusa, La.Twenty-four-hour dietary recalls were collected from 1976 to 1988 on five cohorts of 10-year-olds (n = 1,254), two cohorts of 13-year-olds (n = 360), and young adults (n = 504) 19 to 28 years of age.Dietary fiber intake data were analyzed for age, race, and gender differences and for secular trends. Descriptive and inferential statistics were calculated where appropriate. Dietary composition and food sources were examined for race-specific and gender-specific quartiles for dietary fiber intake adjusted per 1,000 kcal.Even after adjusting for energy intake, total dietary fiber intake remained unchanged from 1976 to 1988, averaging 12 g or 5 g/1,000 kcal. Blacks and males had higher total fiber intakes than whites and females at all ages. Consumption of vegetables and soups and breads and grains accounted for 53% (10-year-olds) to 70% (13-year-olds) of the total fiber consumed. When children were stratified into quartiles on the basis of fiber intake per 1,000 kcal, the percentage of energy from total fat and saturated fat was lower, and the percentage of energy from carbohydrate was higher, in children with higher fiber intakes per 1,000 kcal.Dietary fiber intake of children has remained the same in the past 12 years and is comparable with the intake of young adults, which is well below the recommended level. Children with high fiber intakes (upper quartile) consumed less fat, particularly saturated fat, and more carbohydrate than children with low fiber intakes. Increasing consumption of whole-grain products, fruits, vegetables, and legumes (prepared with minimal added fat) will be necessary to reach the goal of optimal fiber intake and could result in an eating pattern that approaches the current recommendations for dietary fat and saturated fat.

To assess whether circulating insulin is a major contributor to adverse lipid profiles during the transition from adolescence to young adulthood.The association between fasting insulin levels and serum lipid and lipoprotein levels was examined in a cross-sectional survey of 4136 young individuals aged 5 to 30 years from a biracial community.Fasting insulin levels were strongly and positively correlated with serum triglyceride and very-low-density lipoprotein cholesterol levels and negatively correlated with high-density lipoprotein cholesterol levels in all age groups (5 to 11, 12 to 17, 19 to 24, and 25 to 30 years). An increasing impact of insulin level on low-density lipoprotein cholesterol level was observed in young adults aged 25 to 30 years. In multivariate analysis, fasting insulin level was associated with very-low-density lipoprotein cholesterol level for most of the age groups in both races independently of age, sex, glucose levels, obesity, cigarette smoking, and alcohol intake. The independent relationship to low-density lipoprotein cholesterol level persisted in young adults aged 25 to 30 years. The independent and negative association with high-density lipoprotein cholesterol level remained in whites aged 5 to 24 years and blacks aged 19 to 24 years. When individuals were divided into tertiles according to insulin concentration and subscapular skinfold thickness, the independent effect of insulin level and obesity on lipoprotein fractions was also noted. Furthermore, a stronger association of insulin level with lipoprotein fractions was observed in obese than in lean white males.These data indicate that an increasing association of insulin levels with adverse lipoprotein levels in young adults, especially obese individuals, may have adverse consequence for adult cardiovascular diseases.

The association between microalbuminuria and blood pressure levels was examined in young white and black adults (n = 1131) aged 19 to 32 years. Urinary ratio of albumin (mg/L) to creatinine (mmol/L) was used as an estimation of urinary albumin excretion. Black men and women compared with their white counterparts had higher levels of blood pressure. Significantly positive correlations between urinary albumin excretion and systolic and diastolic blood pressures were observed in black men (r = 0.20 and r = 0.24, P.01) and black women (r = 0.15 and r = 0.14, P.05). Similar correlations of significance were not seen in the white counterparts. Systolic and diastolic blood pressure levels were significantly higher in normotensive black subjects (140/90 mm Hg) with increased urinary albumin excretion (or = 90th percentile) than in those without increased urinary albumin excretion. After accounting for potential confounding by age, sex, and body mass index, blacks in the uppermost systolic and diastolic blood pressure group were 7.1 times (95% CI, 2.0 to 25.8) and 4.8 times (1.3 to 18.3), respectively, as likely to have elevated albumin/creatinine excretion as those in the lowest group. In contrast, the likelihood for elevated albumin/creatinine excretion were 0.9 times (95% CI, 0.5 to 2.2) and 1.1 times (0.5 to 2.3), respectively, in whites, which were not significant. These data suggest that a stronger association between blood pressure levels and urinary albumin excretion exists in young blacks than in whites, which supports the notion that blacks may be more susceptible to renal damage from relatively low levels of blood pressure increases.(ABSTRACT TRUNCATED AT 250 WORDS)

Epidemiological studies of BPs in children and young adults over the past 20 years have contributed considerably to understanding the early onset of primary hypertension. Observations from autopsies and echocardiographic studies, together with long-term BP studies, of children clearly indicate that primary hypertension begins in early childhood. Although abnormal BP levels in children are much lower than the adult criteria used for clinical diagnosis of hypertension, essential hypertension is identifiable in early life. Complex haemodynamic and metabolic mechanisms related to essential hypertension are also being identified in childhood. The development of intervention programs in an attempt to prevent hypertension in its early phases suggests hypertensive cardiovascular disease is preventable. Environmental factors (improved dietary factors, altering electrolyte intake, prevention of obesity and increased activity levels) are critical elements to prevention. Children and young adults identified as high risk for hypertension need to be targeted for prevention of early cardiovascular renal disease. Also, as hypertension is so prevalent, attempts should be made to control environmental factors in the general public. Preventive programmes established by primary healthcare physicians, paediatricians and para-professionals can have a major impact on the reduction of hypertension and its complications of cardiovascular renal disease in the future.

Dietary intake of military wives and factors that influence nutrition of military families were examined in 186 military wives--67% white, 18% black, 11% Hispanic, and 4% other. The ages ranged from 19 to 45 years (mean = 28.7 years). The observations show that 1.7 meals per day were shared by all family members. Due to differences in energy intake and RDAs by age, dietary intakes were assessed in two age groups: 19-24 years (N = 51) and 25-45 years (N = 135). For both age groups, total energy intakes were lower than the RDAs, and the dietary composition was 52% carbohydrate (CHO), 14% protein, and 34% fat. Military wives 25-45 years old consumed more CHO in the form of sugar compared to the younger wives, who consumed more CHO in the form of starch. Some families require food stamps and are in the WIC program. There were no age differences in the type of protein or fat consumed, averaging 66% animal protein and 12% saturated fat. Dietary cholesterol intake was 229 mg for wives 19-24 and 243 mg for older wives and, based on approximately 1,900 kcal, dietary cholesterol exceeded 100 mg/1,000 kcal in both age groups. Sodium intake averaged 3.2 g. Forty-five percent of the military wives did not meet two-thirds of the RDA for vitamins D, E, B-6, iron, folic acid, zinc, and magnesium. Less than 20% met two-thirds of the RDA for riboflavin, vitamin A, thiamin, iodine, selenium, and calcium.(ABSTRACT TRUNCATED AT 250 WORDS)

In order to identify potential abnormalities, a cardiovascular risk-factor screening was developed as part of the Fort Polk Heart Smart Program. Serum lipids and lipoproteins, blood pressure, and selected anthropometric indices were measured on 703 individuals. Overweight was more a problem for females, with over 40% having a body mass index greater than 27. The percentage of subjects exceeding National Cholesterol Education Program guidelines increased with age. Some 30% of white men 30-39 years old and 60% of white men above 40 years old had elevated total cholesterol. These observations provide the basis for a health promotion program for young military families.

Lifestyles are major determinants in development of heart disease. Tobacco and alcohol use, physical activity, and hostility, a component of type A, were assessed in a sample of active military men and their wives at Fort Polk, Louisiana. Findings included: (1) a greater frequency of cigarette smoking at Fort Polk compared to national surveys; (2) a higher frequency of alcohol consumption in ages 30-39, and more blacks reported alcohol use than other race groups; (3) a greater frequency of alcohol use at Fort Polk compared to a worldwide military survey; (4) no consistent differences in lipid or blood pressure levels for high and low activity groups of wives; and (5) wives' hostility scores were low, and were not correlated with other cardiovascular risk factors. The implication of lifestyle descriptions is the need for intervention and health promotion, not only for military personnel, but also for their families. The significance of health promotion programs is the eventual reduction of health care costs and the well-being of families and fitness of military personnel.

The relationship between fasting plasma insulin and blood pressure was studied in a cross-sectional survey of children and young adults aged 5 to 26 years.Fasting plasma insulin, glucose, blood pressure, and anthropometric measurements were obtained on 3518 individuals.When divided into four age groups, the analyses showed that fasting insulin was significantly and positively correlated to both systolic and diastolic blood pressure in individuals at all age groups, except at 13 to 17 years. In multivariate regression analyses, fasting insulin remained independently associated with blood pressure levels after controlling for glucose levels, body mass index (weight/height) and skinfold thickness in children (aged 5 to 12 years) and young adults (aged 18 to 26 years), although not in adolescents (aged 13 to 17 years). Moreover, fasting insulin was more strongly related to systolic than to diastolic blood pressure. The fasting blood glucose level did not contribute independently to multivariate prediction of blood pressure in young adults. When the children and young adults were divided into tertiles according to fasting insulin and body mass index, the independent effect of insulin and body mass index on systolic pressure was also seen in children and young adults.The association between plasma insulin and blood pressure noted even in healthy children and young adults help target areas for cardiovascular risk prevention.

To investigate sex differences in the evolution of the QT interval with age.A community-based representative North American population sample of 14,379 children and adults aged from birth to 75 years. The measured QT intervals (QTm) were determined by a computer algorithm and QTm, corrected for heart rate (HR), was expressed as QT index: QTI = (QTm/Tp) x 100, where QTp is the predicted QT from the formula QTp (ms) = 656/(1 + HR/100).The QTI values of females were significantly longer than of males in all age groups from 15 to 50 years tested at yearly intervals. This difference was due to a 20 ms drop in rate-corrected QT values in adolescent males after puberty, whereas QT values of females remained unchanged throughout the growth, maturation and reproductive years. The new QT prediction formula explained 83% of total QT variance in females and 82% in males after adjustment for heart rate and for the observed significant influence of ventricular excitation time (QRS duration) on QT interval in both sexes and a correction for QT age trend in males.The sex difference in the QT interval is due to QT shortening in males after puberty rather than QT prolongation in women during reproductive years. The fact that QRS duration is a significant determinant of the QT interval has important theoretical implications for attempts to model the ventricular repolarization process and it indicates that the traditional concept of reverse sequence of ventricular repolarization is not universally valid in all myocardial regions.

Obesity is an important determinant of serum lipids and lipoproteins in adults. Since obesity begins early in life, the impact of obesity of serum lipid and lipoprotein levels was examined in 3311 children and young adults (ages 5 to 26 years) from a totally biracial community. Study subjects were grouped according to race, sex, and age categories (5 to 10 years, 11 to 16 years, 17 to 22 years, and 23 to 26 years), excluding females using oral contraceptives or who were pregnant. Overall, associations increase with age, being most prominently noted in white males. The strong positive relation of ponderosity to low-density lipoprotein cholesterol was indicated in the older age groups with correlation coefficients ranging from r = -.09 in the youngest black males to r = .47 in white males aged 17 to 22 years. A negative association was noted between ponderosity and high-density lipoprotein cholesterol with correlation coefficients ranging from r = .08 in black females aged 17 to 22 years to r = -.39 in the oldest white males. Similar results were seen using subscapular skin-fold thickness as a measure of central obesity. Overweight was defined as exceeding 20% above the National Health Anthropometric and Nutritional Examination Survey II survey 50th percentiles. The prevalence of overweight individuals increased with age, being most prominent in black females. The percent(s) of hypercholesterolemic cases, based on the National Cholesterol Education Program criteria, likewise increased with age. A marked proportion of older white males were classified as borderline high and high for low-density lipoprotein cholesterol. A regression model using subscapular skinfold to predict serum lipids and lipoproteins within each age group indicated a consistent increase in the adverse nature of the lipid profile. Intervention and education programs aimed at reducing obesity at younger ages are recommended to reduce serum lipid and lipoprotein levels developing in young adulthood.

The distribution of serum uric acid and its relationship with cardiovascular risk variables have been studied in 3983 children and young adults, aged 5 to 26 years, drawn from a biracial (black and white) population. For two age groups, 5 to 11 years and 19 to 26 years, white subjects had significantly higher uric acid levels than black subjects, (4.02 mg/dl vs 3.57 mg/dl, p less than 0.0001, and 5.50 mg/dl vs 5.18 mg/dl, p less than 0.0001, respectively). Men in the 19 to 26 years age group had a significantly higher uric acid level than women (6.49 mg/dl vs 4.20 mg/dl, p less than 0.0001). White children and young adults were twice as likely to have levels above clinical limits than blacks, and males more likely to have hyperuricemia than females. Parents with a history of myocardial infarction were more likely to have children with hyperuricemia. Children and young adults with hyperuricemia had significantly higher plasma glucose (p less than 0.01) and insulin (p less than 0.001) levels, total cholesterol level (p less than 0.05), and serum triglyceride (p less than 0.0001), very-low-density lipoprotein cholesterol (p less than 0.01), low-density lipoprotein cholesterol (p less than 0.001), and total protein (p less than 0.0001) levels than subjects without hyperuricemia; high-density lipoprotein cholesterol level was significantly lower (p less than 0.0001) in subjects with hyperuricemia than in those without it.(ABSTRACT TRUNCATED AT 250 WORDS)

Between the years 1979 and 1981, Louisiana ranked 7th in average annual coronary heart disease (CHD) death rate among white women and 6th among black women, age 35 to 74 years. Nationally, death in women due to CHD is 250,000 deaths per year, mainly in women over 50 years of age. That is approximately one half of all deaths due to heart disease in the United States. Risk factors for CHD in women are those which are shared with men, eg, smoking, hypertension, plasma lipoprotein concentrations, obesity, diabetes, and family history, and those which apply solely to women, eg, contraceptive use, menopause, and postmenopausal hormones. The purpose of this manuscript is to review current knowledge regarding CHD in women.

Multiple strategies are available to affect children's cardiovascular health. From clinic-based high-risk counseling to broad-based school or community programs, intervention strategies are being developed and tested to find the most effective means of changing the risk factors of youth to assure a healthier future for our children. Since adoption of new behaviors is improved by consistent messages from multiple sources, a concerted effort is needed. The involvement of health professionals, educators, community organizations, industry, and government together will be important to support the adoption of healthy lifestyles for succeeding generations. Intervention through cardiovascular health promotion for school children may well be the future direction for preventive cardiology.

The distributions of serum creatinine levels and their relationship with selected anthropometric and cardiovascular risk variables have been described in 3983 children and young adults, aged 5 to 26 years, obtained from a biracial population, Bogalusa, Louisiana. For both blacks and whites serum creatinine levels increased slowly with age, until 11 years of age when a steeper increase occurred to around 19 years of age. Before this age there was a significant age by sex interaction (p less than 0.0001) in the distributions of serum creatinine. After the age of 19 years mean serum creatinine levels were significantly higher in black men than in white men (1.16 mg/dl vs 1.09 mg/dl, p less than 0.0005) and in black women than in white women (0.87 mg/dl vs 0.84 mg/dl, p less than 0.08). Creatinine levels were also significantly higher in men than in women (1.11 mg/dl vs 0.85 mg/dl, p less than 0.0001). Creatinine clearance, estimated from an equation using serum creatine, age, and weight, showed a steady increase until 13 years of age when a maximum range of 120 to 140 ml/min was reached. By the age of 19 years the clearance had declined to a relatively constant range of 100 to 120 ml/min. Black men had the highest correlation of serum creatinine concentration with height, weight, and lean body mass after adjusting for age. White men had the highest correlation of serum creatinine concentration with uric acid. Diastolic blood pressure becomes an important determinant of creatinine levels by the age of 11 years. The race-sex differences in serum creatinine levels in children and young adults are likely related to body mass.

Many advances have now been made in understanding the early natural history of coronary artery disease and essential hypertension, an understanding that these diseases begin in childhood and that CVD relates to clinical cardiovascular risk factors. Methods have now been established to determine risk factors in the pediatric age and, with a family history, to begin to identify children at potential risk for premature heart disease. Advances have also been made in developing models for intervention and beginning prevention through both high-risk and population strategies directed at schoolchildren. Obviously, both approaches are needed and complement each other. An impressive future is ahead for effective preventive cardiology beginning with children by incorporation of cardiovascular health education and health promotion in elementary schools. Applying behavioral concepts to intervention programs can strengthen their chances of success. The overall good of having children adopt healthy life-styles with an understanding of their necessity is now attainable. It will be the responsibility of physicians to guide the direction of programs being promoted for children.

It is necessary to examine lipid abnormalities at a macromolecular level, with emphasis on the transport lipoproteins rather than on cholesterol and triglyceride values alone. Methods for determining serum lipoproteins, which can be adapted for a small laboratory, are now available and are recommended for general clinical use. It is becoming increasingly apparent that the process of atherosclerosis has a long natural history that begins in childhood, and that it is now possible to study children for potential risk.

Social and behavioral learning methods, combined with nutrition counseling and innovative education modules, provide a well-rounded approach to eating behavior intervention. Dietitians can apply this multifaceted approach in various settings to maximize eating behavior change.

A large pedigree (N = 356) with a high prevalence of heart disease and associated adverse lipoprotein phenotype was studied. The adverse lipoprotein phenotype is characterized by both low levels of high-density-lipoprotein cholesterol (HDL-C) alone (16.3%) and in combination with other adverse lipoprotein levels (12.8%). In all, 44.2% of all pedigree members had at least one adverse lipoprotein level. Analysis of mating types showed that all lipids and lipoproteins possess familial clustering with 25-36% of offspring above median levels when both parents had levels below the median, while 67-83% had levels above the median when both parents had levels above the median. Using adjusted lipid and lipoprotein levels, a statistically significant linear trend was found between the degree of relationship to pedigree members with heart disease, and both the low-density-lipoprotein cholesterol/high-density-lipoprotein cholesterol (LDL-C/HDL-C) ratio (P less than .05), and the very-low-density-lipoprotein cholesterol (VLDL-C; P less than .01) level. A similar analysis using the prevalence of adverse lipoprotein levels as the dependent variable and degree of relationship to heart diseased pedigree numbers as the independent variable showed significant (P less than .05) relationships with VLDL-C and the LDL-C/HDL-C ratio. Further genetic analyses of this pedigree may reveal genetic mechanisms responsible for the familiality of lipoprotein levels in this pedigree.

The value of BP measurements and family history of cardiovascular disease in predicting future BP status was studied in 1,501 children, initially 2 to 14 years of age, who were examined four times during an 8-year period in the Bogalusa Heart Study. Correlation coefficients between year 1 and year 9 BPs were as follows for systolic and diastolic BPs, respectively: 0.41 and 0.35 (P less than .0001). These correlations were significant in all age groups. For children in the upper quartile of BP at any one prior examination, the percentage remaining in the year 9 upper quartile ranged from 41% to 52% for systolic BP and 35% to 44% for diastolic BP. Three serial BP measurements in the upper quartile increased the percentages remaining in the upper quartile to 68% for systolic BP and 62% for diastolic BP. Conversely, of those children not in the upper quartile of systolic BP at year 9, 96.8% did not have all three prior measurements in the upper quartile. Family history of hypertension was shown to independently predict year 9 systolic BP status. These results confirm the importance of serial BP measurements and family history of hypertension for the practicing physician.

The Heart Smart Family Health Promotion identified elementary-school-age children with elevated blood pressure (BP), based on sex-, race-, height-specific 90th percentiles, and ponderal index (wt/ht3), based on sex-, race-, and age-specific 90th percentiles (norms developed in the Bogalusa Heart Study). These children and their parents were recruited into a behavioral program aimed at reducing cardiovascular (CV) risk factors for both children and parents and preventing "tracking" of children's elevated risk factors into adulthood. Cardiovascular screening consisted of BP, anthropometric evaluation, serum lipids, and 24-hour urinalysis. Self-reported assessments were personal and family medical history, eating, exercise, smoking, and alcohol behaviors. Both child and parent subjects were predominantly black and female. Data were stable over two baseline measurements and indicated CV risk factor abnormalities in one or both of the parents selected: 67% of the black parents and 25% of the white parents were hypertensive; 91% had positive familial CV history; 41% had total cholesterol greater than or equal to 220 mg/dl; 50% had LDL-C levels greater than or equal to 140 mg/dl; 74% were overweight; 44% were smokers; and 91% were completely sedentary. Using percentile grids to identify children with elevated BP also identifies families with hypertension and associated risk factors.

Free and protein-bound serum sugars and serum lipids were analyzed in 65 adult diabetic patients, 10 age-matched controls, and 24 male medical students for correlation of carbohydrate changes with the extent of retinal, renal, and cardiovascular disease. In diabetic sera, both protein-bound sugars and free mannose, fucose, and hexosamine were significantly elevated; free galactose and inositol were elevated in some diabetic patients, and essentially undetectable in sera from controls. Serum triglycerides and pre-beta-lipoproteins were also elevated in diabetics, but alpha-lipoproteins decreased. Although no specific relationships were observed with the extent of retinal and renal disease, bivariate analyses by Pearson coefficients of correlation showed correlations between levels of serum-free mannose and systolic blood pressure, free hexosamine and duration of diabetes, and serum protein-bound fucose and age. Serum triglycerides and pre-beta-lipoprotein levels correlated with insulin therapy. These are preliminary leads of laboratory studies related to carbohydrate macromolecular changes which might aid in a better understanding of the cardiovascular complications associated with diabetes.

Normal levels and trends of cardiovascular disease risk factors in childhood have been well documented by numerous epidemiologic surveys. Expected levels of blood pressure, lipids and lipoproteins, and body size can be determined by the child's physician using race- and gender-specific grids. These grids allow for the identification and follow-up of children with high-risk profiles. Evidence of increased left ventricular mass and vascular changes in renal arteries in association with childhood blood pressure level along with atherosclerotic fatty streak and fibrous plaque development in the aorta and coronary arteries shows that children with elevated risk factors are at risk for early target organ damage. These data demonstrate the potential importance of early intervention on the natural history of cardiovascular disease. Based on our own data from the Bogalusa population, as well as evidence from other epidemiologic investigations in children, the following recommendations can be made, regardless of the risk factor variable under consideration: Cardiovascular disease risk factor variables should be measured carefully and in a serial manner to classify a child as abnormal. Serial measurements serve to reduce the effect of regression to the mean and increase the predictive value of the measurements. The misclassification of normal children into the high-risk category can be avoided by serial and replicate observations. Interventions that have attendant side effects (for example, pharmacologic therapy for high blood pressure) have to be measured against the effectiveness of diet, exercise, and other aspects of primary prevention. Risk factor levels consistently greater than the ninetieth percentile deserve medical attention. Care should be taken prior to using specific grids of normal levels of cardiovascular disease risk factors in children. The measurement techniques employed on individuals should be similar to those used by the epidemiologic study to generate the grids in a reference population. The grids should become part of the child's permanent medical record, as they provide a rapid visual assessment of the cardiovascular disease risk profile over time. High-risk trackers may require more intensive follow-up and will allow for early intervention and an assessment of the efficacy of the intervention program. In conclusion, cardiovascular disease risk factor screening in childhood is quick, effective, and inexpensive. The potential payoff in prevention of adult cardiovascular disease is enormous and allows the physician to provide more comprehensive care to a pediatric population.

We assessed the relation of risk factors for cardiovascular disease to early atherosclerotic lesions in the aorta and coronary arteries in 35 persons (mean age at death, 18 years). Aortic involvement with fatty streaks was greater in blacks than in whites (37 vs. 17 percent, P less than 0.01). However, aortic fatty streaks were strongly related to antemortem levels of both total and low-density lipoprotein cholesterol (r = 0.67, P less than 0.0001 for each association), independently of race, sex, and age, and were inversely correlated with the ratio of high-density lipoprotein cholesterol to low-density plus very-low-density lipoprotein cholesterol (r = -0.35, P = 0.06). Coronary-artery fatty streaks were correlated with very-low-density lipoprotein cholesterol (r = 0.41, P = 0.04). Mean systolic blood-pressure levels also tended to be higher in the four subjects with coronary-artery fibrous plaques than in those without them: 112 mm Hg as compared with 104 (P = 0.09). These results document the importance of risk-factor levels to early anatomical changes in the aorta and coronary arteries. The progression of fatty streaks to fibrous plaques is uncertain, but these data suggest that a rational approach to the prevention of cardiovascular disease should begin early in life.

Cardiovascular risk factors in childhood are related to arterial wall changes that lead to atherosclerotic coronary artery disease in later life. Atherosclerosis begins early in life. The observations of early arterial wall connective tissue changes and accompanying early lipid deposition show the importance of understanding cardiovascular risk factors in children. Since risk factors found in childhood are potentially predictive of adult coronary heart disease, methods for prevention of atherosclerosis should begin in children. Rational strategies should be directed to removing atherogenic forces that work in a child at high risk. Primary prevention of atherosclerosis has its maximal potential when begun before advanced irreversible lesions can occur. Consideration needs to be directed to how cardiovascular connective tissue changes and lipid and calcium deposition can be modulated in the injury and healing processes. It is important to recognize that adult coronary artery disease is really a major pediatric problem.