Preventive cardiology and its potential influence on the early natural history of adult heart diseases: the Bogalusa Heart Study and the Heart Smart Program

Diet and Food and Nutrition Insecurity and Cardiometabolic Disease

Poor nutrition is the leading cause of poor health, health care spending, and lost productivity in the United States and globally, which acts through cardiometabolic diseases as precursors to cardiovascular disease, cancer, and other conditions. There is great interest in how the social determinants of health (the conditions in which people are born, live, work, develop, and age) impact cardiometabolic disease. Food insecurity is an example of a powerful social determinant of health that impacts health outcomes. Nutrition insecurity, a distinct but related concept to food insecurity, is a direct determinant of health. In this article, we provide an overview of how diet in early life relates to cardiometabolic disease and then continue to focus on the concepts of food insecurity and nutrition insecurity. In the discussions herein we make important distinctions between the concepts of food insecurity and nutrition insecurity and provide a review of their concepts, histories, measurement and assessment devices, trends and prevalence, and links to health and health disparities. The discussions here set the stage for future research and practice to directly address the negative consequences of food and nutrition insecurity.

Changes in body size phenotypes from childhood to adulthood and the associated cardiometabolic outcomes

AIM

To examine the effects of changes in body size phenotypes between childhood and adulthood on risks of diabetes and left ventricular hypertrophy (LVH) in adulthood.

METHODS

We included 3,351 individuals who participated as both children and adults in the Bogalusa Heart Study.

RESULTS

Compared with participants with persistently metabolically healthy normal weight (MHNW) from childhood to adulthood, MHNW children who became metabolically unhealthy in adulthood had increased diabetes burden and LVH risk in adulthood; Metabolically unhealthy normal weight (MUNW) children who became MHNW or metabolically healthy obese (MHO) as adults and individuals with persistent MHO from childhood to adulthood were not at increased risks of diabetes or LVH. The risks were increased if MHO during childhood transitioned to metabolically unhealthy obesity (MUO) by adulthood or MUO stayed from childhood to adulthood. MUO children who became MHO or MHNW as adults had decreased diabetes burden and LVH risk in adulthood.

CONCLUSIONS

Individuals maintained MHO from childhood to adulthood and MUNW children who became MHO as adults had a diabetes burden and LVH risk similar to individuals with persistent MHNW. Progression to metabolically unhealthy status and maintenance of metabolically unhealthy status, regardless of childhood BMI status, were associated with increased cardiometabolic outcomes.

Perivascular adipose tissue (PVAT) in atherosclerosis: a double-edged sword

Perivascular adipose tissue (PVAT), the adipose tissue that surrounds most of the vasculature, has emerged as an active component of the blood vessel wall regulating vascular homeostasis and affecting the pathogenesis of atherosclerosis. Although PVAT characteristics resemble both brown and white adipose tissues, recent evidence suggests that PVAT develops from its own distinct precursors implying a closer link between PVAT and vascular system. Under physiological conditions, PVAT has potent anti-atherogenic properties mediated by its ability to secrete various biologically active factors that induce non-shivering thermogenesis and metabolize fatty acids. In contrast, under pathological conditions (mainly obesity), PVAT becomes dysfunctional, loses its thermogenic capacity and secretes pro-inflammatory adipokines that induce endothelial dysfunction and infiltration of inflammatory cells, promoting atherosclerosis development. Since PVAT plays crucial roles in regulating key steps of atherosclerosis development, it may constitute a novel therapeutic target for the prevention and treatment of atherosclerosis. Here, we review the current literature regarding the roles of PVAT in the pathogenesis of atherosclerosis.

Secondhand Smoke Exposure and Preclinical Markers of Cardiovascular Risk in Toddlers

OBJECTIVE

To investigate relationships between secondhand smoke exposure in young children and several preclinical markers of cardiovascular risk that have been established as relevant to adult populations.

STUDY DESIGN

There were 139 children, 2-5 years of age, enrolled in a cross-sectional study. Secondhand smoke exposure was objectively determined by hair nicotine level; a comprehensive panel of clinical markers (morning blood pressure, fasting glucose and insulin, lipid profiles, inflammation) and research markers (markers of oxidation, endothelial stress, and endothelial repair) of cardiovascular risk status were assessed. Univariate and multivariate linear regression were used to evaluate relationships between secondhand smoke exposure and cardiovascular risk markers.

RESULTS

Hair nicotine levels were correlated directly with blood pressure and serum C-reactive protein, and inversely correlated with serum high-density lipoprotein cholesterol and endothelial cell progenitor cell prevalence. In multivariate analyses, these relationships remained when controlled for age, sex, body mass index z-score, maternal education, and method of payment. Additionally, in multivariate analyses, hair nicotine level was significantly negatively correlated with total antioxidant capacity.

CONCLUSIONS

These results support the view that secondhand smoke exposure in the very young has a detectable relationship with several markers of cardiovascular risk, long before the emergence of clinical disease. Further studies to define mechanisms and strategies to prevent and mitigate these risks early in life are warranted.

Genetic association and gene-smoking interaction study of carotid intima-media thickness at five GWAS-indicated genes: the Bogalusa Heart Study

OBJECTIVES

To examine the associations of five GWAS-identified genes with carotid intima-media thickness (IMT) in a biracial sample from the Bogalusa Heart Study, and evaluate their participation in gene-smoking interactions.

METHODS

Far wall IMTs of common carotid arteries were measured using high-resolution B-mode ultrasound. Both the gene-smoking interactions and single-marker associations were evaluated by linear models of carotid IMT levels, while the gene-based analyses were assessed through the truncated product method. A Bonferroni multiple testing correction was applied.

RESULTS

Marker rs7840785 (PINX1) was significantly associated with right carotid IMT (p=0.0003) using all participants; mean levels for the CC, TC, and TT genotypes were 0.74 (0.73 to 0.75), 0.76 (0.75 to 0.78), and 0.78 (0.75, 0.81), respectively. Similar trends were observed in blacks (p=0.0031) and whites (p=0.0118). Marker rs7844465 (ZHX2) was significantly associated with left carotid IMT in whites (p=0.0005); mean IMT levels for the GG, TG, and TT genotypes were 0.73 (0.71 to 0.74), 0.75 (0.74 to 0.77) and 0.78 (0.75 to 0.81), respectively. Marker rs6841473 (EDNRA) modified the association between smoking and left carotid IMT in blacks (p=2.79×10(-5)). In addition, gene-based analysis demonstrated that EDNRA and ZHX2 were associated with left carotid IMT in the white and overall participants, respectively, while PINX1 was associated with right carotid IMT in both blacks and whites.

CONCLUSION

We identified two novel markers that were associated with IMT in both blacks and whites. One gene-smoking interaction was identified in blacks only. Three genes showed gene-based associations with IMT levels. However, genetic markers with small effects may have been missed due to the limited number of black participants.

Genomic risk models improve prediction of longitudinal lipid levels in children and young adults

In clinical medicine, lipids are commonly measured biomarkers used to assess an individual's risk for cardiovascular disease, heart attack, and stroke. Accurately predicting longitudinal lipid levels based on genomic information can inform therapeutic practices and decrease cardiovascular risk by identifying high-risk patients prior to onset. Using genotyped and imputed genetic data from 523 unrelated Caucasian Americans from the Bogalusa Heart Study, surveyed on 4,026 occasions from 4 to 48 years of age, we generated various lipid genomic risk models based on previously reported markers. We observed a significant improvement in prediction over non-genetic risk models in high density lipoprotein cholesterol (increase in the squared correlation between observed and predicted values, ΔR (2) = 0.032), low density lipoprotein cholesterol (ΔR (2) = 0.053), total cholesterol (ΔR (2) = 0.043), and triglycerides (ΔR (2) = 0.031). Many of our approaches are based on an n-fold cross-validation procedure that are, by design, adaptable to a clinical environment.

Clinical practice: the effect of obesity in children with congenital heart disease

Childhood obesity has reached epidemic proportions in many parts of the world. This epidemic has also affected children and adults with congenital heart disease (CHD). Over one quarter of children with CHD are overweight or obese. Important comorbidities are associated with obesity including type 2 diabetes, systemic hypertension, hyperlipidemia, and obstructive sleep apnea. Obese children with CHD often have the traditional risk factors such as genetic predisposition, sedentary lifestyle, and poor dietary habits. However, they may also have unique risk factors such as higher caloric needs in early infancy and exercise restriction in childhood. Similar to children with normal hearts, those with CHD have higher left ventricular mass and abnormal vascular function and are more likely to have systemic hypertension. In the long term, these comorbidities may have a more profound effect on children who have underlying functional and/or anatomical abnormalities of the heart. As more children with CHD are now surviving into adulthood, investigating therapeutic interventions to treat and prevent obesity in this population is of utmost importance. Recommendations for safe physical activity, recreation sport, and exercise training for children with CHD have recently been published. These guidelines may help health care providers to change their practice of exercise restriction.

Childhood risk factors predict cardiovascular disease, impaired fasting glucose plus type 2 diabetes mellitus, and high blood pressure 26 years later at a mean age of 38 years: the Princeton-lipid research clinics follow-up study

The objective was to assess whether pediatric risk factors predict cardiovascular disease (CVD), impaired fasting glucose (IFG) + type 2 diabetes mellitus (T2DM), and high blood pressure (HBP) in young adulthood. We performed a prospective follow-up of 909 public-parochial suburban schoolchildren first studied at ages 6 to 18 years and 26 years later at a mean age of 38 years. Pediatric triglycerides (TGs), blood pressure, low-density lipoprotein cholesterol, body mass index, and glucose above and high-density lipoprotein cholesterol below established pediatric cutoffs, along with race, cigarette smoking, family history of CVD, T2DM, and HBP, were assessed as determinants of young adult CVD, a composite variable including IFG + T2DM and HBP. By stepwise logistic regression, adult CVD (19 yes, 862 no) was associated with pediatric high TG (odds ratio [OR], 5.85; 95% confidence interval [CI], 2.3-14.7). High TG in pediatric probands with young adult CVD was familial and was associated with early CVD in their high-TG parents. Adult IFG + T2DM (114 yes, 535 no) was associated with parental T2DM (OR, 2.2; 95% CI, 1.38-3.6), high childhood glucose (OR, 4.43; 95% CI, 2-9.7), and childhood cigarette smoking (OR, 1.64; 95% CI, 1.03-2.61). Adult HBP (133 yes, 475 no) was associated with pediatric high body mass index (OR, 2.7; 95% CI, 1.7-4.3) and HBP (OR, 2.5; 95% CI, 1.5-4.3). Pediatric risk factors are significantly, independently related to young adult CVD, IFG + T2DM, and HBP. Identification of pediatric risk factors for CVD, IFG + T2DM, and HBP facilitates initiation of primary prevention programs to reduce development of adult CVD, IFG + T2DM, and HBP.

The child as proband for future parental cardiometabolic disease: the 26-year prospective Princeton Lipid Research Clinics Follow-up Study

OBJECTIVE

To evaluate children's cardiovascular disease (CVD) risk factors as predictors of parents' subsequent CVD, type 2 diabetes mellitus (T2DM), and high blood pressure (HBP).

STUDY DESIGN

We conducted a 26-year prospective follow-up of 852 5- to 19-year-old black and white schoolchildren (mean age, 12 years; Lipid Research Clinics, 1973-8), and parents (mean age, 40 years) from 519 families in Princeton Schools, Cincinnati, Ohio. Schoolchildren were reassessed in the Princeton Follow-up study 1999-2003 at mean age 39 years; CVD, T2DM, and HBP history of their 1038 parents were reassessed by mean age 66 years. We assessed relationships of childhood risk factors with parental CVD, T2DM, and HBP. Child-probands identified with triglyceride (TG) levels, blood pressure, low-density lipoprotein cholesterol levels, body mass index (BMI), and glucose level greater than and high-density lipoprotein cholesterol levels less than established cutoff points.

RESULTS

Pediatric HBP (P=.006) and low high-density lipoprotein cholesterol (P=.018) were predictive of parental CVD at age ≤50 years. Pediatric HBP (P=.02) and high TG (P=.03) were predictive of parental CVD at age ≤60 years. Pediatric high TG (P=.009) and high low-density lipoprotein cholesterol (P=.04) were predictive of parental CVD by age 66 years. Pediatric high BMI (P=.0006) were predictive of parental T2DM. Pediatric high BMI (P=.003) and black race (P=.004) were predictive of parental HBP.

CONCLUSIONS

Pediatric risk factors identify families with parents at increased risk for CVD, T2DM, and HBP, emphasizing the usefulness of the child as proband.

Longitudinal replication studies of GWAS risk SNPs influencing body mass index over the course of childhood and adulthood

Genome-wide association studies (GWAS) have identified multiple common variants associated with body mass index (BMI). In this study, we tested 23 genotyped GWAS-significant SNPs (p-value<5*10-8) for longitudinal associations with BMI during childhood (3-17 years) and adulthood (18-45 years) for 658 subjects. We also proposed a heuristic forward search for the best joint effect model to explain the longitudinal BMI variation. After using false discovery rate (FDR) to adjust for multiple tests, childhood and adulthood BMI were found to be significantly associated with six SNPs each (q-value<0.05), with one SNP associated with both BMI measurements: KCTD15 rs29941 (q-value<7.6*10-4). These 12 SNPs are located at or near genes either expressed in the brain (BDNF, KCTD15, TMEM18, MTCH2, and FTO) or implicated in cell apoptosis and proliferation (FAIM2, MAP2K5, and TFAP2B). The longitudinal effects of FAIM2 rs7138803 on childhood BMI and MAP2K5 rs2241423 on adulthood BMI decreased as age increased (q-value<0.05). The FTO candidate SNPs, rs6499640 at the 5 '-end and rs1121980 and rs8050136 downstream, were associated with childhood and adulthood BMI, respectively, and the risk effects of rs6499640 and rs1121980 increased as birth weight decreased. The best joint effect model for childhood and adulthood BMI contained 14 and 15 SNPs each, with 11 in common, and the percentage of explained variance increased from 0.17% and 9.0*10(-6)% to 2.22% and 2.71%, respectively. In summary, this study evidenced the presence of long-term major effects of genes on obesity development, implicated in pathways related to neural development and cell metabolism, and different sets of genes associated with childhood and adulthood BMI, respectively. The gene effects can vary with age and be modified by prenatal development. The best joint effect model indicated that multiple variants with effects that are weak or absent alone can nevertheless jointly exert a large longitudinal effect on BMI.

Prevention and treatment of atherosclerosis: a practitioner's guide for 2008

Atherosclerosis causes nearly 75% of cardiovascular-related deaths and is found in 80% to 90% of adults >/=30 years old in the United States. Successful treatment minimizes lifetime chances of cardiovascular events, morbidity, and mortality. Risk factors for atherosclerosis should be monitored, beginning in childhood, even in asymptomatic patients. Modifiable factors (e.g., blood pressure, smoking, serum lipids) and nonmodifiable factors (e.g., age, family history) are important in the overall assessment. Clinicians and patients can partner to produce an individualized treatment plan by choosing from a variety of standard approaches. In some patients, improved dietary choices, increased exercise, and smoking cessation will reduce risk to an acceptable degree. To lower risk further, lipid-lowering pharmacotherapy and antihypertensive medication may be combined with these lifestyle improvements. For most of these patients, reducing low-density lipoprotein cholesterol is the most important lipid-lowering goal, and it is best achieved with a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin). Some patients may benefit from adjunctive therapies that have proven effects (e.g., niacin, fibrates, plant stanols/sterols, omega-3 fatty acids). Antihypertensive regimens may involve stepwise adjustments of multiple medications. Good clinical judgment and communication of expectations and goals are critical for effective management of atherosclerosis.

Obesity is a common comorbidity in children with congenital and acquired heart disease

OBJECTIVES

Obesity may pose additional cardiovascular risk to children with acquired and congenital heart disease. Many children with heart disease are sedentary as a result of physician-, parent-, and/or self-imposed restrictions. The aim of this study was to evaluate the impact of the epidemic of obesity on children with heart disease.

PATIENTS AND METHODS

A cross-sectional review was performed of children evaluated in 2004 at 2 cardiology outpatient clinics. Differences in the prevalence of obese (BMI > or = 95%) and overweight (BMI 85%-95%) children were compared with national data and healthy control subjects. Dictated letters were reviewed to determine whether obesity was discussed with referring practitioners.

RESULTS

Of 2921 patients assessed, 1523 had heart disease. Diagnostic subgroups included "mild" heart disease (n = 401), arrhythmia (n = 447), biventricular repair (n = 511), univentricular palliation (Fontan; n = 108), and heart transplantation (n = 56). More than 25% of the patients with heart disease were obese or overweight; the prevalence of obese and overweight children was significantly lower only in the Fontan group (15.9%). Pediatric cardiologists failed to document obesity or weight counseling in the majority of clinic letters.

CONCLUSIONS

Obesity is common in children with congenital and acquired heart disease. Pediatric cardiologists demonstrate inadequate communication regarding this problem to referring practitioners. Healthy-lifestyle counseling and routine exercise in children with heart disease may be underemphasized.

Plasma homocysteine concentrations in Greek children are influenced by an interaction between the methylenetetrahydrofolate reductase C677T genotype and folate status

Risk factors established at young ages may set the stage for later cardiovascular disease (CVD). Elevated total homocysteine (tHcy) in blood is an emerging risk factor for CVD, yet few studies have been conducted in children, especially in the Mediterranean. We described plasma tHcy concentrations in a group of healthy Greek children and examined its relation with physiologic, metabolic, and genetic variables. Fasting blood samples were collected from 186 students, 11.6 +/- 0.4 years old, and tHcy, folate, vitamin B-12, and routine biochemistry variables in plasma were measured. The methylenetetrahydrolate reductase (MTHFR) C677T genotype was determined and anthropometric and dietary data were obtained. The distribution of tHcy was positively skewed with a median of 7.9 micromol/L (mean: 8.2 +/- 2.3 micromol/L; range: 4.4-22.2 micromol/L). tHcy was inversely related to plasma folate (r = -0.34, P < 0.0001), vitamin B-12 (r = -0.20, P = 0.008), and glucose (r = -0.15, P = 0.045). An interaction between the MTHFR genotype and plasma folate on tHcy was detected (P = 0.047). Specifically, the homozygous mutant TT genotype was associated with higher tHcy only in children with lower plasma folate (< 19.9 nmol/L), (P = 0.012). In our sample of healthy Greek children, plasma tHcy concentrations were higher than values reported in children of Northern European descent and were associated with folate, vitamin B-12, and glucose in plasma. The results also show that, similar to adults, plasma folate concentration is important in determining the contribution of the MTHFR C677T mutation to tHcy concentrations in children.

Social inequalities in biomarkers of cardiovascular risk in adolescence

OBJECTIVE

Cardiovascular disease, which begins early in life but often is not manifest until adulthood, is the nation's leading cause of mortality. Social inequalities in cardiovascular disease are pervasive, yet the process by which they accrue is poorly understood. The objective of this study was to explore the associations between socioeconomic status, a range of biomarkers reflective of cardiovascular risks, and a cumulative physiological risk score among adolescents.

METHODS

Non-Hispanic black and white high school students (N = 758) in a suburban Midwestern public school district had a physical examination to measure height, weight, and waist circumference and a fasting morning blood sample drawn to assess cortisol, insulin, glucose, glycosylated hemoglobin, fibrinogen, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, and triglycerides. A cumulative risk score was created from these physiological measures and waist circumference. Information on parent education and household income was obtained from a parent in a separate survey. Generalized estimating equation models were used to assess the association of parent education to the risks and the cumulative risk score adjusting for age, gender, and race.

RESULTS

Lower parent education was associated with higher insulin, higher glucose, greater insulin resistance, higher LDL cholesterol, lower HDL cholesterol, higher waist circumference, and higher body mass index (p <.05 for all), but not cortisol, fibrinogen, glycosylated hemoglobin, or triglycerides in adjusted analyses. Cumulative risk scores ranged from 0 to 7 and were highly skewed; the median risk score was 1. A total of 7.4% had risk scores of 4 or more. Lower parent education was also associated with higher cumulative risk score (p <.001) and this association was maintained after adjustment for body mass index. Risk scores were highest, on average, among those with insulin levels greater than 1 standard deviation above the mean (mean risk score = 3.2, standard error = 0.18, median = 3).

CONCLUSION

Lower parent education is associated with multiple metabolic risks and cumulative risk in adolescents, suggesting that there is a strong intergenerational transfer of education's influence on cardiovascular health. Our data imply that regulation of insulin may be a key factor underlying the influence of lower parent education on cardiovascular health early in the life course.

L'activité physique habituelle au cours du développement

The three objectives of the present review of the literature were to: characterize the evolution of habitual physical activity (HPA) during growth; evaluate the tracking of HPA from childhood to adulthood; and analyse the level of HPA in children and adolescents according to public health recommendations. Data indicates that HPA decreases from childhood to adulthood about 7% per year, with a great reduction during puberty and adolescence concurrent to changes in the type of physical activity. It appears that HPA is not quite steady (0.09 <  r <  0.66) during growth, which means that behavioural changes occur. Being very active during childhood or adolescence does not necessarily translate into a high level of HPA in adulthood. The mean values of HPA of children and adolescents vary from 15 to 90 min•day−1 between studies, and for most of them HPA has been higher or close to public health recommendations. However, these results mask a great number of children and adolescents who are inactive or becoming inactive (40 to 45% of the population). Key words: children, adolescents, heart rate monitoring, questionnaire, health

Dietary intake as a cardiovascular risk factor in Costa Rican adolescents

PURPOSE

To evaluate Costa Rican adolescents' dietary intake as a cardiovascular disease (CVD) risk factor.

METHODS

Dietary intake was determined using 3-day food records; nutrient content of fast foods prepared in school cafeteria was calculated by the weighted records.

RESULTS

Around 30% of adolescents exceed the American Heart Association dietary recommendation for total fat and saturated fat. About 50% reported a cholesterol intake higher than 100 mg/1000 kcal. On average, 45% of adolescents do not meet the dietary fiber recommendation of 10 g/1000 kcal, the 66% of the recommended daily allowance for vitamins E and B(6), or around 25% for folic acid. A higher proportion of urban adolescents do not satisfy the established dietary recommendation to prevent CVD.

CONCLUSIONS

To avoid further increases in the Costa Rican CVD mortality rate, it is necessary to develop primary prevention programs, oriented to modify adolescent's nutrition habits. Schools have the potential to carry out such programs, as at least 60% of all adolescents in Costa Rica are enrolled in high schools.

Changes in common activities of 3rd through 10th graders: the CHIC study

PURPOSE

This study was a longitudinal examination of the change in both the activities done and the intensity of those activities from childhood to adolescence.

METHODS

Common activities were assessed by questionnaire initially on 656 subjects from 21 elementary schools; 50.5% were female, 83.4% were Caucasian, 20.6% African-American, and 6.0% were other races.

RESULTS

Girls more often reported sedentary activities overall. Weighted least squares analyses showed boys consistently reported more vigorous activities than girls (P < 0.0008). African-American girls reported fewer vigorous activities than Caucasian or other race girls (P = 0.027). Sedentary activities were more frequently reported with increasing age (X2 P < 0.001). The youngest African-American and Caucasian boys reported similar activity patterns. However, boys from other races reported more intense activities until sixth and seventh grades when African-American boys began reporting more sedentary activities than Caucasians or other races (P = 0.004). During sixth-eighth grades, Generalized Estimating Equations (GEE) models show that girls with more advanced pubertal status reported more sedentary activities than girls who were less developed (P < 0.0001). For high school girls, race was a marginally significant predictor (P = 0.05) of activity status. Neither race nor pubertal status were significant factors in activities chosen by middle school boys. However, for male high school students, Caucasians were more likely than African-Americans to report vigorous activities (P = 0.005).

CONCLUSIONS

Variation in activities by race within gender suggests that establishing activity patterns in youth may be race-specific as well as gender-specific and must be accounted for in designing physical activity interventions. Also, pubertal maturation is a factor in activity choices in middle school girls.

Heart disease in children

Advances in the understanding of the pathophysiology, diagnosis, and medical and surgical management of neonates with cardiovascular disease has led to their improved survival rates. These improvements have resulted in an increased number of pediatric patients presenting to the primary care physician's office with underlying heart disease. Understanding the genetic, congenital, or acquired etiologies to the various pediatric heart diseases is crucial to preventing these lesions and treating these patients.

The relationship of childhood to adult blood pressure: longitudinal study of juvenile hypertension in Lithuania

OBJECTIVE

To assess changes in blood pressure from childhood to adulthood and the ability to predict adult blood pressure.

DESIGN

Longitudinal study of a cohort of children with baseline data and a follow-up survey after 20 years.

SETTING

Epidemiological survey of schoolchildren and subsequent inhabitants of Kaunas, a town in Lithuania.

PARTICIPANTS

The children came from 15 schools and accounted for 25% of all 12- and 13-year-old children born in 1964 in Kaunas. The first survey (n = 1082) was carried out in 1977. The same population was re-examined in 1997 (n = 505). Data from 217 men and 288 women, who participated in both the first and the most recent surveys, is presented.

MAIN OUTCOME MEASURES

Systolic and diastolic blood pressure at the age of 32-33 years.

RESULTS

In the 20 years between the two surveys blood pressure increased more in men than in women. Statistically significant correlation between childhood and adult blood pressure levels was estimated (for systolic blood pressure r=0.40 in men and r=0.24 in women; for diastolic blood pressure r=0.14 in men and r=0.34 in women). Stepwise regression analysis of the data showed that the best predictors of adult blood pressure were the initial childhood blood pressure levels and change in BMI during the 20-year period for both men and women. Other factors were less predictive.

CONCLUSIONS

Childhood blood pressure is related to adult levels and, together with changes in body mass index, is a significant predictor of adult blood pressure.

Cardiovascular risk factors and behavior lifestyles of young women: implications from findings of the Bogalusa Heart Study

The primary purposes of this article are to highlight important issues related to cardiovascular risk factors and behavior life-styles in young women and to examine racial (black-white) differences in risk factors that relate to cardiovascular disease. In childhood, some girls show cardiovascular risk factors of higher blood pressure levels, dyslipidemia, and obesity, all of which continue into young adulthood. Factors that contribute to abnormal risk factors are a high-saturated fat diet, excess energy intake related to inactivity, and cigarette smoking. Trends of obesity are documented; and young white girls are continuing to use tobacco, more so than boys and black girls. Although the onset of clinical cardiovascular disease is delayed in women, the stage is set in childhood for the development of early cardiovascular risk.