CHILDHOOD PREDICTOR OF ADULT CORONARY ARTERY DISEASE

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Advances toward improving cardiovascular health lie in the recognition that pathogenesis of atherosclerosis begins in childhood. The aim of this research is to identify childhood markers or traits for adult coronary artery disease (CAD). Given the familial nature of atherosclerosis, essential hypertension, and diabetes mellitus, the research is based on hypotheses that children of coronary-prone parents show early evidence of abnormalities in parameters related to atherogenesis and thrombogenesis, and that childhood predictors of CAD risk may vary between blacks and whites, and may even be influenced by gender differences of adult heart disease. These hypotheses will be tested in a total biracial community of Bogalusa, Louisiana, taking advantage of the resources and an extensive data base of the ongoing Bogalusa Heart Study program. Longitudinal changes in lipoprotein profiles and other risk factor variables during childhood and adolescence in offspring of parents with clinically proven CAD in comparison to matched group of offspring of parents unaffected by CAD will be determined by a retrospective data analysis. A unique data set of a cohort of about 2,000 young adults aged 18 to 31 years with a 15 year data span of cardiovascular risk factors including lipoproteins is available for this purpose. A second study will use reported family histories of CAD from two cross-sectional surveys (1987-88 and 1992-94 each including over 3,500 children, ages 5-17 years). This involves selection of black and white families (N = 50 each) that have at least one parent (aged 30 to 55 years) with clinically validated CAD. Appropriately matched control families with no family history of the disease will be studied as well. Parents will be given a regular cardiovascular risk factor examination. Children (aged 8 to 19 years, N = 250-300) of these case-control families will be studied in depth including an oral fat load test to evaluate the post-prandial triglyceride-rich lipoprotein metabolism. Data will be obtained on 1) anthropometric variables related to body fat distribution, 2) serum lipoprotein variables (total cholesterol, triglycerides, VLDL-C, LDL-C, HDL2-C, HDL3-C, HDL-apoE, LpA- l, LpA-l:All, apoA-l, apoB, LDL-apoB, apoE, HDL-apoE, and LDL lipid peroxides) and related candidate genes (Lp(a), apo(a) phenotypes, and apoE phenotypes), and 3) other variables related to atherosclerosis and thrombosis (glucose, insulin, thromboxane, prostacycline, von Willebrand factor antigen, fibrinogen, fibrin degradation products, homocysteine, and uric acid). The study of heritability and penetrance by linkage of relevant candidate gene markers in multiple generations of these index families remains a long-term objective. White blood cells from children and parents will be collected and stored for this purpose. Understanding childhood predictors of adult CAD in a biracial population can lead to more rational programs for health promotion and disease prevention.