James L. Cresanta

Relation of serum lipoprotein levels and systolic blood pressure to early atherosclerosis. The Bogalusa Heart Study.

Abstract 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<0.01). However, aortic fatty streaks were strongly related to antemortem levels of both total and low-density lipoprotein cholesterol (r = 0.67, P<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-fa...

Tracking of cardiovascular disease risk factor variables in school-age children☆

Persistence in ranks (tracking) for cardiovascular disease risk factor variables was examined in 2236 children who were screened three times over a 5-yr period. As expected, the greatest persistence was noted for height (r = 0.47-0.99) and weight (r = 0.70-0.96). Correlation coefficients for systolic blood pressure and diastolic blood pressure ranged from 0.38 to 0.66 and 0.22 to 0.49 respectively. Among lipids, the correlations were highest for serum beta-lipoprotein cholesterol ranging from 0.62 to 0.78. For those children who were at or above the 90th percentile on a risk factor variable during the first examination, a tendency to retain their ranks in the second and third examinations was noted. For systolic blood pressure, 35% of those initially high remained high in the second examination and 30% in the third examination. Correspondingly, for those initially high for beta-lipoprotein cholesterol, 47 and 41% remained high. A linear discriminant model was used to distinguish characteristics of children who persisted at high rankings and those who did not. The model was effective for total and beta-lipoprotein cholesterol, but only moderately so for systolic blood pressure.

Transitions of cardiovascular risk from adolescence to young adulthood--the Bogalusa Heart Study: II. Alterations in anthropometric blood pressure and serum lipoprotein variables.

Cardiovascular (CV) risk factors change over time with the emergence of clinically recognizable abnormalities (obesity, hypertension and hyperlipoproteinemia) in the second and third decades of life. A cohort of 286 subjects, aged 11-15 in 1973-74 were reexamined 6 years later to observe changes in height, weight, blood pressure, lipids and lipoproteins between adolescence and adulthood. During the 6 years of follow-up, 10-11 year-old males increased 30 cm in height and 32 kg in weight. Among 10-11 year-old girls, height increased 12-15 cm and weight increased 15 kg in whites and 20 kg in blacks. Mean systolic BP increased 16-23 mmHg in black males and 11-15 mmHg in white males. Mean serum total cholesterol levels increased with age such that levels in 20 year olds were 160-190 mg/dl, about 10 to 15 mg/dl higher than 18 year olds. In white males beta-lipoprotein cholesterol increased (13 mg/dl) with age; however, there was a simultaneous decrease in alpha-lipoprotein cholesterol (11 mg/dl), resulting in a dramatic rise in the beta-LPC/alpha-LPC ratio. These adverse changes in LPC may be related to the early development of atherosclerosis and risk for coronary heart disease of young white men. Early identification of hypertension and hyperlipoproteinemia should help to predict and prevent future CV disease.

The association between cardiovascular response tasks and future blood pressure levels in children: Bogalusa heart study

Children were selected from a total community survey and categorized into three blood pressure (BP) groups (low less than 10 percentile, midrange 10 to 90 percentile, high greater than 90 percentile) based on resting diastolic pressure (DBP). To examine the relationship of cardiovascular reactivity with BP levels 4 years later, three cardiovascular response tasks (orthostatic, handgrip, and cold pressor) were administered. Partial correlations, adjusted for initial resting BP, showed that peak BP responses to the three tasks were related to future resting systolic and diastolic BP. Further analyses showed that DBP reactivity was related to future BP tracking in children with high DBP levels. In the high DBP group, while resting DBP levels did not differ for trackers vs nontrackers, peak DBP responses to each of the three tasks did (orthostatic, p less than 0.001; handgrip, p less than 0.05; cold pressor, p less than 0.01). The combination of resting and peak BP levels may provide more powerful predictions of future BP levels in children.

Prevention of Atherosclerosis in Childhood

Atherosclerosis begins in infancy, with fatty streaks appearing at the age of 3 years and fibrous plaques appearing during adolescence. Fatty streaks and fibrous plaques are related to serum total cholesterol, LDL-C, and systolic blood pressure levels. Children with elevated levels of cholesterol and blood pressure track (i.e., maintain elevated levels over time) and are candidates for premature coronary artery and cerebrovascular disease, especially if there is a positive family history of premature CVD. Screening for CVD risk factors in children is rapid, simple, inexpensive, and effective, with tremendous potential to prevent future adult CVD. At their annual physical examinations, children 5 years of age or older should have careful blood pressure measurements by two observers, and determinations of serum total cholesterol levels. Levels should be plotted on standard percentile grids (Figs. 5-7) in the childs permanent medical record. Those with persistently elevated levels of blood pressure and/or serum LDL-C require nonpharmacologic intervention initially, but may require antihypertensive or antilipid medication if unresponsive to behavioral modification for diet, physical activity, and cigarette smoking. Pediatric health professionals can play vital roles in primary prevention and reduction of adult CVD.

Transitions of cardiovascular risk from adolescence to young adulthood—The Bogalusa heart study: I. Effects of alterations in lifestyle

Adolescence and young adulthood represents a transition period for biologic and lifestyle characteristics. In a preliminary investigation of young adults (ages 18-20 years), the Bogalusa Heart Study documented patterns of alcohol, tobacco, and oral contraceptive use, as well as changes in education, occupational, marital and parenting status. Such behaviors accelerate the cardiovascular disease process and may differentially influence risk factor patterns of race and sex groups. Adverse levels of systolic blood pressure and alpha-lipoprotein cholesterol were more frequent in married vs single men; elevated triglyceride levels were more frequent in married vs single whites. However adverse levels of beta- and alpha-lipoprotein cholesterol were more frequent in nonparents than in parents. Cigarette smoking and oral contraceptive use were independently related to elevated beta-lipoprotein cholesterol and decreased alpha-lipoprotein cholesterol levels of young white women. Alcohol consumption was highest among white males, with 32% reporting daily consumption of the equivalent of two or more beers or one mixed drink. Alcohol consumption was negatively correlated with blood pressure in white males and positively correlated with alpha-lipoprotein cholesterol in black males. Since such lifestyle factors are related to physiologic risk factors that result in heart disease and adult cardiovascular morbidity and mortality in the older ages, early targeting during adolescence and young adulthood is important.

Black-white contrasts as determinants of cardiovascular risk in childhood: Precursors of coronary artery and primary hypertensive diseases☆

Atherosclerosis and hypertension begin in childhood. Studies of children have identified black-white differences in anthropometric, hormonal, enzymatic, and renal mechanisms related to the development of coronary artery disease and hypertension. Black children have greater body density, higher blood pressure, and higher serum total cholesterol, alpha-lipoprotein cholesterol, and insulin levels, whereas white children have a higher percentage of body fat, a faster heart rate, and higher hemoglobin, serum triglyceride, pre-beta-lipoprotein cholesterol, plasma renin, and dopamine-beta-hydroxylase levels. At puberty, white male children have decreased high-density lipoprotein (HDL) levels and increased low-density lipoprotein/HDL ratios. Black children have lower urinary K+ excretion and demonstrate natriuresis when K+ is administered orally. These black-white contrasts provide clues for studying disease development early in life. Rational approaches to primary prevention of atherosclerosis and hypertension may require a diversity of strategies because of these black-white differences.

Serum lipoprotein levels in children: Epidemiologic and clinical implications

Abstract Serum total cholesterol and lipoprotein cholesterol (LPC) were measured in a standardized laboratory in 3568 fasting children and youths, age 5–17 yr, in a biracial population of a total community. Between ages 11–15 yr, mean serum total cholesterol declined 3 mg/dl per year from 155 mg/dl to 143 mg/dl. Both α-LPC (7 mg/dl) and β-LPC (7 mg/dl) decreased while pre-β-LPC (2 mg/dl) increased during adolescence. Measurement errors, based upon a 10% blind duplicate random subsample, and race-sex adjustment factors, were determined for each lipid. Measurement errors were 4 mg/dl for serum total cholesterol and 6, 5 and 2 mg/dl for serum α-, β- and pre-β-LPC respectively. Measurement errors generally exceeded race-sex adjustment factors. For each fasting child serum total cholesterol was standardized for race, sex and age. Deciles for these total cholesterol relative deviates were determined. Mean total and lipoprotein cholesterol were calculated for each decile for each of the four race-sex groups. Both α-LPC and β-LPC steadily increased as the total cholesterol relative deviates increased, but the rate of increase in β-LPC exceeded that for α-LPC. As percentages of total cholesterol relative deviates. β-LPC greatly increased while α-LPC markedly decreased at higher deciles in all race-sex groups. Percentile tables for each lipid were listed with recommendations for use by clinicians caring for children in daily office practice. Guidelines were suggested for total cholesterol and LPC determinations in clinical practice. Children with a total cholesterol level greater than 185 mg/dl should have lipoproteins determined which will enable judgement for therapeutic decisions. Lipid data and lipoprotein ratios from nine selected white male adolescents in the study were presented and discussed. The results suggested a biologic link between earlier post-mortem studies of premature coronary atherosclerosis in young white male adults and epidemiologic studies of coronary heart disease in older adults. Because of the remarkable changes in lipoprotein patterns during adolescence, young men are appropriate targets for the study of methods for intervention to prevent coronary heart disease.

Distributions of serum lipoproteins in children by repeated measurements

Serum lipids and lipoproteins were measured three times over 6 years in a total-community study of children in Bogalusa, Louisiana. Interrelationships and changes in the distributions of serum lipoprotein cholesterol levels were examined in terms of variability and precision of the laboratory measurements. Although distributions of serum lipoprotein cholesterol variables shifted among the three surveys, precision increased markedly as indicated by a decrease in the coefficient of variation for measurement error for total cholesterol, alpha-lipoprotein cholesterol, and triglycerides between Year 1 and Year 4 and then stabilized. Pre-beta-lipoprotein cholesterol was the most difficult variable to measure. The range and magnitude of correlation coefficients between lipid and lipoprotein variables were very similar. Despite quality controls, efforts to standardize laboratory analyses, and adherence to protocols, fluctuations in distributions of lipids and lipoproteins occurred when the same population was restudied. Long-term studies for coronary artery disease prevention should include laboratory safeguards that help to distinguish modest population changes in serum lipids and lipoproteins from laboratory drift.