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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.

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 examine the usefulness of childhood low-density lipoprotein cholesterol (LDL-C) measurement for predicting future dyslipidemia and other cardiovascular risk in adulthood.A longitudinal cohort over 15 years was identified from a community study of the natural course of arteriosclerosis: 1169 individuals (34% black), aged 5 to 14 years, were included at initial study.Levels of lipoprotein variables in childhood were associated with levels in adulthood, more strongly for total cholesterol (r = .4-.6) and LDL-C (r = .4-.6) than for high-density lipoprotein cholesterol (r = .2-.4) and triglycerides (r = .1-.4). In a stepwise multiple regression, the childhood level was most predictive of the adulthood level, followed by change in body mass index (weight in kilograms/height in meters squared) from childhood to adulthood, with explained variability (R2) of .29, .30, .27, and .19 for total cholesterol, LDL-C, high-density lipoprotein cholesterol, and triglycerides, respectively. Adulthood dyslipidemia, as defined by the National Cholesterol Education Program criterion, was best predicted by childhood LDL-C level among other lipoprotein variables. Compared with subjects with acceptable childhood risk (LDL-C level,2.84 mmol/L [110 md/dL]), those (6%) with high childhood risk (LDL-C level,or = 3.36 mmol/L [or = 130 mg/dL]) not only had a higher prevalence of dyslipidemic total cholesterol level (24%, 8.3-fold), LDL-C level (28%, 5.4-fold), triglyceride level (7%, sevenfold) and lower HDL-C level (14%, 2.1-fold), but also had a significantly higher (P.05) prevalence of obesity (43%, 1.6-fold) and hypertension (19%, 2.4-fold). In addition, if the childhood LDL-C elevation (90th percentile) was persistent, the prevalence of adult dyslipidemia would be markedly increased (P.001).Adverse levels of LDL-C in childhood persist over time, progress to adult dyslipidemia, and relate to obesity and hypertension as well. National Cholesterol Education Program guidelines to classify cardiovascular risk on the basis of LDL-C level are helpful in targeting individuals at risk early in life.

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.

Cardiovascular risk factors are known to persist over time and to cluster both in childhood and adulthood. Less is known about the persistence of clustering of multiple cardiovascular risk factors comprising adverse levels of systolic blood pressure, the ratio of total cholesterol to high-density lipoprotein cholesterol, and plasma insulin from childhood to young adulthood.In a community study of cardiovascular risk, 1176 individuals (52% female, 44% black) aged 5 through 17 years at baseline were followed up for 8 years.Calculated as sum of the race-, sex-, and age-specific rankings of systolic blood pressure, insulin level, and total to high-density lipoprotein cholesterol ratio, the multiple risk index was shown to track in all four race-sex groups (year 1 vs year 8 correlations, .54 to .67). The magnitude of the overall multiple risk index tracking correlation (r = .64) was significantly stronger than that noted for individual risk factors (r = .34 to .57). Among subjects who were initially in the highest quintile of the multiple risk index, 61% remained there 8 years later. Tracking of the multiple risk index increased progressively with age and ponderal index (weight/[height3]). In a step-wise regression analysis, baseline multiple risk index score, baseline ponderal index, change in ponderal index, and change in height were predictive of the multiple risk index score on follow-up. These predictors explained 45% to 60% of the variability in multiple risk index scores among the race-sex groups.The persistence of multiple cardiovascular risk clustering from childhood to adulthood and the impact of obesity in this regard point to the need for preventive measures aimed at developing healthy lifestyles early in life.

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)

This paper introduces three cardiovascular health evaluation and promotion projects targeting military families at Fort Polk, Louisiana. These studies examine dietary behavior and life-styles including tobacco and alcohol use of military wives, physical activity, cardiovascular disease risk factors of military personnel and their families, and other behavioral profiles with the goal of developing a healthy lifestyle modification program for families. Relevant biomedical background and rationale considerations are developed to support the current research. In addition, conclusions drawn from these studies indicate the opportunity for future health promotion programs at other military installations. The studies will provide the background for a manual of operations to conduct health promotions for families on a military base. Further, the model provides the opportunity for a social support mechanism for families during times of stress and military operations.

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.

Serum lipid and lipoprotein distributions and their correlates were examined in white, black, and Hispanic Army personnel and their families (N = 589) as part of the Fort Polk Heart Smart Program. In general, blacks tended to have higher HDL-C and lower triglycerides and VLDL-C than whites and Hispanics, whereas Hispanics tended to manifest higher triglycerides, VLDL-C, and LDL-C than whites. Unlike black and Hispanic men, white men tended to have lower HDL-C than white women. In contrast to white men, both black and Hispanic men displayed elevated LDL-C compared with black and Hispanic women. A considerable proportion of individuals tended to manifest adverse lipoprotein patterns according to National Cholesterol Education Program guidelines for children and adults. Cigarette smoking and alcohol use were the major contributors to the variance of lipoproteins in men, whereas overweight and oral contraceptive use remained the major factors in this regard for women. These results indicate that early targeting of military personnel and their family members for primary prevention is highly desirable.

Various electrolytes and energy intakes have been shown to contribute to the risk of hypertension and other cardiovascular diseases. Further, dietary sodium (Na) and potassium (K) balance are important in both nonpharmacologic and pharmacologic management of various cardiovascular states. Emphasis is also given to weight reduction and electrolyte balance. As an aid to food selection to enhance K intake and decrease Na intake, we have categorized foods according to their electrolyte density as related to caloric content. More than 100 individual food items were assigned to one of four categories. Ratios of individual Na, K, and energy content were calculated, based on USDA-generated food nutrient values. Category 1 includes foods that are low in Na, high in K and low in energy: fresh or frozen vegetable sources with vitamins A and C. Category 2 contains foods low in Na relative to high K and high energy: most fruit, starchy vegetables, nuts, milk and meat products, and chocolate. Category 3 includes foods high in Na that are also high in K in relation to low energy: vegetables (canned, frozen in butter sauce or au gratin), most cheeses, cured or frozen meats. Category 4 contains foods high in Na and low in K relative to high energy: bread, rice, luncheon meats, commercial cookies and pastries, and fast food entrees. Commercial cereals could be differentiated by the guidelines, with bran cereals in Category 1, shredded wheat products in Category 2, fruit-containing cereals in Category 3, and presweetened or instant cereals in Category 4. Identification of the ratio of Na and K to content of foods, compared with relative energy ratio, is useful in selecting foods that will help meet specific dietary criteria for management of essential hypertension and other cardiovascular-renal states, both in the adult and pediatric populations.

A self-administered food frequency questionnaire (FFQ) was developed to indicate weekly consumption of 64 foods. Reliability, validity, and usefulness of the tool to define a protein eating pattern were determined. Adolescents (N = 1,108) completed the FFQ during the Bogalusa Heart Study. Two-hour and 2-week reliability measures demonstrated consistency of intake of specific foods. Frequency of foods obtained from seven consecutive 24-hour recalls was compared with frequency obtained from the FFQ. A mean 50% agreement for both frequency and quantity of food intake was observed. Geometric means showed differences in mean number of protein foods by age of adolescent but the only significant difference was for beef intake of 15-year-olds. White children reported more servings of beef, cheese, and vegetables with meat than did black children. Black children reported more servings of eggs, luncheon meat, pork, poultry, and total protein than did white children. Boys reported a greater frequency of total protein foods, specifically, eggs, milk, and poultry, than did girls. Significant correlations were noted between low-density-lipoprotein cholesterol and intake of eggs and luncheon meat. We were able to quantitate the reliability and validity of the FFQ and to use it to explore the association of specific eating patterns with cardiovascular disease risk.

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)

Serum lipids (total cholesterol and triglycerides) and lipoprotein cholesterol fractions (low density lipoprotein (LDL) cholesterol, very low density lipoprotein (VLDL) cholesterol, and high density lipoprotein (HDL) cholesterol) have been measured approximately every 3 years on children and young adults since 1973-1974 in Bogalusa, Louisiana, a community of approximately 22,000 individuals, one-third of whom are black and two-thirds of whom are white. A total of 1,586 children were examined both at baseline (1973-1974) and at the most recent survey (1984-1986), providing 12 years of follow-up. The decreases in levels noted during puberty for total cholesterol and LDL cholesterol, primarily for boys, were followed by a rise until age 26 years. HDL cholesterol levels, particularly for white boys, continued to drop after age 14 years, yielding increasingly high LDL cholesterol/HDL cholesterol ratios. Tracking, as measured by both correlation coefficients and persistence at extreme quartiles, was evident for all of the lipids and lipoproteins. The 12-year correlation coefficients were greatest for LDL cholesterol and no trend in the magnitude of the correlation coefficients with age was noted. Tracking for HDL cholesterol was better after age 9 years, particularly for white males. Approximately 50% of those children who had total cholesterol levels or LDL cholesterol levels above the 75th percentile at baseline remained elevated 12 years later. For HDL cholesterol, a trend with age was noted for white boys: 42% of those aged 9-14 years in the lower most quartile persisted in this rank 12 years later. The best predictor of follow-up lipid or lipoprotein level was baseline level. The next best predictor was increase in weight as defined by weight/height, an index of obesity. That serum lipid and lipoprotein levels continue to track from childhood into young adulthood points to the necessity of measurement early in life and, where indicated, the introduction of preventive and interventional programs aimed at developing healthy lifestyles.

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.

Arterial wall structure and function, an important determinant of cardiovascular (CV) disease, are influenced by CV risk factors, especially high levels of blood pressure and low-density lipoprotein cholesterol (LDLC). However, the differential impact of these two risk factors on arterial structure and function in healthy, asymptomatic younger adults is not clear. This aspect was examined in 1003 black and white adults aged 23-43 years enrolled in the Bogalusa Heart Study. Carotid artery intima-media thickness (IMT) (an average of common, bulb and internal carotid on both sides) and aorta-femoral pulse wave velocity (PWV) measured by B-mode ultrasound were used as indicators of artery structure and function. Values of IMT (0.83 mm) and PWV (5.4 m/sec) in blacks were significantly higher than IMT (0.80 mm) and PWV (5.2 m/sec) in whites, respectively (p

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.

Height, weight, and skinfold measurements were obtained on a cohort of 447 children from birth (weight) or 6 months of age (height and skinfold) and monitored yearly thereafter until 7 years of age. At age 7 years, 250 remained for follow-up screening. A significant degree of tracking was found for all variables from age 1 to age 7 years. Height and weight tracked most strongly (age 1- to 7-year correlations = .42 and .44, respectively), whereas skinfold tracked somewhat lower (.28). Earlier levels of each anthropometric variable were the best predictor of later levels of that parameter. Implications for early detection and treatment of growth abnormalities are discussed.

Cardiovascular risk factor variables were examined in a cohort of 440 infants from birth through 7 years of age. Anthropometric measures, BP, serum lipid and lipoprotein values, and dietary intake data were obtained according to detailed protocols. Various quality controls to ensure the collection of valid and reliable data were instituted. Participation remained high throughout the study with 80% of the children examined at 6 months and 60% at 7 years of age. Rates were slightly higher for black than for white children. Children born in the private hospital were more likely to continue in the study than children born in the charity hospital. Children of parents examined when the child was 2 years of age were more likely to be examined during the preschool phases, but parental examination was not related to child examination when the child was 7 years of age. As in studies of school-aged children, measurement errors were lowest for height, weight, and serum total cholesterol. Measurement errors for BP were highest at the younger ages, particularly for diastolic BP. Examination of a newborn cohort throughout time affords the opportunity to study early development of relationships and tracking of cardiovascular risk factors.

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.

Despite encouraging reductions in mortality rates from coronary heart disease (CHD), it remains a major public health problem and the leading cause of death in the United States. Although various explanations have been proposed for declining death rates, a consensus exists regarding the importance of lifestyle alterations for risk factor reduction. Because cardiovascular (CV) risk-related behavioral patterns are acquired during childhood, numerous school-based CV health promotion programs have been implemented. The effectiveness of CV research studies for children during the last decade are reviewed. Intervention strategies to prevent heart disease include (1) the population or public health approach and (2) the high-risk approach. The "Heart Smart" model intervention project is utilized to describe these two main strategies. Policy, position statements, and initiatives on CV risk factors from major professional societies and associations, in addition to governmental organizations and offices, are also provided. Primary care physicians, particularly pediatricians and family practitioners, as well as cardiologists can play a crucial role in the prevention of CHD and essential hypertension through efforts and practices in their offices, the schools, and the community at large. The changing and expanding role of physicians interested in preventive child health care is emphasized, including involvement in school- and community-based CV health promotion programs. More comprehensive CV model projects such as "Heart Smart," which intervene on the total school environment, are critical to the reduction of CV disease in the United States and abroad.

Diets of four groups of 10-year-old children (no. = 871, 30% black, 70% white) were examined over 10 years with 24-hour dietary recalls to study temporal trends in cholesterol, fat, and fatty acid intakes in a community. Boys had higher intakes per day and per kilogram body weight than girls for all nutrients (p less than .0001), but there were no sex differences in nutrients per 1,000 kcal. The only racial difference detected was a higher myristic acid intake in whites (p less than .02). There was a 16% decline in dietary cholesterol intake between 1978 and 1982. Three shifts in fatty acid intake increased the P:S ratio from 0.29 in 1973 to 0.45 in 1978: (a) a 5% decline in oleic acid, coupled with a 5% rise in linoleic acid; (b) a quadrupling of linolenic acid; and (c) less stearic and more myristic acid, with palmitic acid unchanged. Total fat intake provided 38% of the calories in each survey, but the changes in proportions of fatty acids paralleled trends in food consumption patterns and nutrient sources. Despite the changes, few children met prudent diet recommendations, and serum total cholesterol and very-low-density-lipoprotein cholesterol levels did not change over time.

Chemical analysis of food actually eaten would be the most accurate method for analyzing the diets of children, but this technique is not feasible for most nutrition staffs. An improved 24-hr. dietary recall can be used by a small, well trained staff to collect more reliable data on a large number of school children. Vigilant monitoring of school lunch operations, incorporation of known recipes in the ETNV, and organizing probing techniques are necessary to insure the reliability of the tool. The low coefficients of variation of duplicate recalls noted in the study indicate that the error of measurement between interviewers is small, if the tool is carefully tested and sophisticated before use in the field and if observers are carefully trained by a written protocol.

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.

This paper provides the rationale, design, description, and evaluation of a unique comprehensive health promotion model, wherein an interdisciplinary group of professionals from three organizations--a medical school, university, and community collaborated to implement a cardiovascular (CV) health project entitled "Heart Smart" on a total school environment (K-6). Preliminary program findings are reported. Major lessons learned are also discussed which suggest a number of recommendations for the successful adoption of a school-based CV health intervention. The expertise and interaction of a multidisciplinary group of health care, research, and educational professionals has been a successful endeavor which has greatly enhanced the quality of the health promotion model for "Heart Smart." More comprehensive models such as "Heart Smart," which intervene on a total school environment, are vital to the reduction of CV disease in the United States and abroad.

Dietary patterns and racial differences in nutrient intake were observed in children 6 months to 4 years of age in the Bogalusa Heart Study. Even in this sample of young children, the composition of the intakes of the majority of children was not compatible with prudent recommendations of less than 35% and 10% of energy from total and saturated fat, respectively. Mean cholesterol intake of the 4-year-old children (390 mg) was approximately one half of the average daily adult levels. The polyunsaturated to saturated fatty acid ratio ranged from 0.41 to 0.53 and sucrose to starch ratio from 1.32 to 1.57, reflecting a high saturated fat and sucrose intake. White children had greater intakes of sucrose than black children; however, total fat and cholesterol intakes were greater in black children. Gender differences were noted among the 2, 3, and 4-year-old children: energy, sugar, and starch intakes were greater in boys, and cholesterol intake per 1,000 kcal was greater in girls. Mean intakes per 1,000 kcal in Bogalusa were higher for fat and carbohydrate and lower for protein than reported in the Second Health and Nutrition Examination Survey. However, when the National Research Council recommended dietary allowances for protein and energy are used for comparison, a more than adequate intake was noted in these children. The data found in this newborn-infant cohort contribute information regarding the early development of dietary habits that likely influence eating behavior in later childhood and adolescence.

Serum lipids and lipoprotein cholesterol fractions were examined in a newborn cohort that was followed from birth to 7 years of age. Although white and female infants had higher cord blood levels of high-density lipoprotein cholesterol (HDL-C) than did black and male infants, respectively, these differences did not persist throughout early childhood. Mean levels of all serum lipids and lipoproteins increased greatly in the first 6 months of life, and by 2 years of age, levels approached those seen in adolescents. Infants consuming cow's milk had higher 6-month levels of serum total cholesterol and low-density lipoprotein cholesterol than did formula-fed infants. However, milk source in infancy did not significantly influence total cholesterol or low-density lipoprotein cholesterol levels at age 7 years. Serum lipid and lipoprotein levels at age 7 years were associated with previously measured levels as early as 6 months of age, and infants with unfavorable levels were likely to have similar adverse levels at 7 years of age. In addition, increases in obesity between 6 months and 7 years of age were positively associated with increases in levels of serum triglycerides. These results suggest that certain persons at increased risk for cardiovascular disease can be identified in infancy.

A large pedigree with high prevalence of heart disease is investigated to analyse the association between polymorphic blood markers and quantitative risk factors for cardiovascular disease. The analysis incorporates a familial correlation structure among the individuals in the pedigree and a generalized power transformation to induce approximate residual normality of the risk factors. A total of 380 marker/risk factor combinations are analysed, and at the normal 1% significance level, positive associations are found between the A antigen of the ABO locus and both serum total cholesterol and low-density lipoprotein cholesterol, and negative associations are found between the B antigen of the ABO locus and serum total cholesterol, and between the B allele of acid phosphatase (AP) locus and systolic blood pressure.

Clinical and anatomical observations from the Bogalusa Heart Study over a 15-year span provide data on cardiovascular risk factors and the early natural history of arteriosclerosis. These studies established that: cardiovascular risk can be predicted in early life; interrelationships of risk factors in children are similar to those observed in adults; and concentrations of serum lipoproteins change during sexual maturation. Strategies involving the general population and high-risk groups should be considered to help reduce atherosclerosis and coronary artery disease. Active modification of risk factors in the general populace would include using such methods as screening, education, and mass-media campaigns. Educational promotion ("Heart Smart") has already been implemented in the New Orleans area, focusing on using the total school environment to teach cardiovascular health and to encourage children to adopt desirable lifestyles. Inclusion of cardiovascular health education into general educational studies of children should be a major objective of the future.

BP was measured in 440 children followed longitudinally from birth to 7 years of age in Bogalusa, LA. Levels, trends, and determinants of BP were evaluated in this newborn cohort. Both systolic and diastolic BP levels remained relatively constant between the ages of 6 months and 7 years. BP levels varied between the different instruments, and differences were also noted between measures obtained using the same instrument before and after venipuncture. White children were noted to have slightly higher levels of systolic and diastolic BP pressure at 6 months and 1 year of age, even after adjustment for body size. Significant prediction of year 7 BP rank occurred as early as 6 months of age for systolic and at 1 year of age for diastolic BP levels. Body size was inconsistently related to BP levels from ages 6 months through 4 years, but the relationship was stronger and more consistent with changes in body size. Of interest is the relatively constant levels of indirect BP during this period of rapid growth, as measured by currently available instruments. These data emphasize the importance of cardiovascular risk factor measurement during early life and of the need to improve methods of indirect BP measurement in infancy.