Gender divergence on the impact of multiple cardiovascular risk factors on the femoral artery intima-media thickness in asymptomatic young adults: the Bogalusa Heart Study

IntroductionGender divergence on the impact of multiple cardiovascular risk factors on the femoral artery intima-media thickness (IMT) has not been studied in a biracial (black-white) community-based asymptomatic young adults.MethodsFemoral IMT was measured by B-mode ultrasonography in 1080 individuals (age, 24–43 years; 71% white; 43% men) enrolled in the Bogalusa Heart Study.ResultsFemoral IMT showed a gender difference (men > women; P = 0.001), but no racial difference. In a multivariate model, age, cigarette smoking, systolic blood pressure and total cholesterol to high-density lipoprotein cholesterol ratio related independently, in that order, to IMT in women, and age and low-density lipoprotein cholesterol in men. In women, mean IMT increased with increasing number of risk factors defined as values above the age-, race- and gender-specific 75th percentile of systolic blood pressure, waist circumference, total cholesterol to high-density lipoprotein cholesterol ratio and insulin along with positive smoking status (P for trend = 0.001), with respective mean IMT (mm) values of 0.61, 0.65, 0.72 and 0.77, for 0, 1 to 2, 3 and 4 to 5 risk factors. There was no such significant trend in men.ConclusionsAlthough men versus women had thicker IMT, the observed increasing trend of femoral IMT with increasing number of risk factors in asymptomatic young women suggests that women may be relatively more susceptible to the burden of multiple risk factors.     

Cardiovascular risk profile of asymptomatic healthy young adults with increased femoral artery intima-media thickness: The Bogalusa Heart Study

BACKGROUND: Femoral artery intima-media thickness (IMT), like carotid IMT, is a surrogate indicator of atherosclerotic coronary and peripheral vascular diseases in middle-aged and older adults. This study examined the cardiovascular disease risk profile of asymptomatic young adults with increased femoral artery IMT. METHODS: Femoral artery IMT was measured by B-mode ultrasonography in 1080 black and white subjects (aged 24-43 years; 71% white, 43% male) enrolled in the Bogalusa Heart Study. Individuals in the top (n=54) versus bottom fifth (n=54) percentiles distribution of femoral IMT were compared for traditional cardiovascular risk factors profile. Univariate analysis compared the two groups, t-tests and chi tests were performed. RESULTS: The top and bottom fifth percentiles of IMT differed with respect to age (P<0.001), systolic blood pressure (P<0.05), diastolic blood pressure (P<0.05), total cholesterol (P<0.01), low-density lipoprotein (LDL) cholesterol (P<0.001), non-high-density lipoprotein (HDL) cholesterol (P<0.01) and smoking status (P<0.01). In terms of prevalence of clinically defined traditional risk factors, individuals at the top versus bottom fifth percentile of IMT distribution had significantly higher prevalence of high LDL cholesterol (>OR=130 mg/dL), non-HDL cholesterol (>OR=160 mg/dL), and cigarette smoking. The odds ratio for individuals with three or more risk factors versus no risk factors having IMT in the top fifth percentile was 4.7 (P=0.01). CONCLUSION: The observed adverse effect of cardiovascular risk factors on IMT of femoral artery, a surrogate measure of coronary and peripheral atherosclerosis, in asymptomatic young individuals underscores the need for risk factors profiling in early life. These observations have important implications in preventive medicine.     

Impact of multiple coronary risk factors on the intima-media thickness of different segments of carotid artery in healthy young adults (The Bogalusa Heart Study)

Although risk factors for coronary artery disease are also associated with increased carotid artery intima-media thickness (IMT) as measured by B-mode ultrasonography in middle-aged and older persons, information on the impact of multiple risk factors on the IMT of different segments of the carotid artery in young adults is limited. This relation was examined in a sample of 518 black and white subjects (mean age 32 years; 71% white, 39% male) enrolled in the Bogalusa Heart Study. IMT was thicker and more skewed in the bulb compared with other carotid segments. Race differences (blacks more than whites) were noted for the common carotid (p <0.001) and carotid bulb (bifurcation) IMT (women only, p <0.001). Men had a greater IMT in the common carotid (p <0.05), internal carotid (p <0.05), and carotid bulb (whites only, p <0.001). In a multivariate analysis, systolic blood pressure, race, age, low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein (HDL) cholesterol weree entered into a model in that order and accounted for the 16.7% variance in the common carotid IMT; age, systolic blood pressure, HDL cholesterol, LDL cholesterol, race, and insulin levels explained the 19.4% variance in the carotid bulb IMT. Gender and body mass index (BMI) accounted for the 4.7% variance in the internal carotid IMT. Increases in IMT with increasing number of risk factors (cigarette smoking, higher total cholesterol to HDL cholesterol ratio, higher systolic blood pressure, greater waist circumference, and higher insulin level) were noted for the common carotid and carotid bulb segments (p for trend <0.001 for both). The observed deleterious trend of increasing IMT at different carotid segments with increasing number of risk factors in free-living, asymptomatic young subjects underscores the importance of profiling multiple risk factors early in life. Ultrasonography of carotid arteries, especially at the bifurcation, may be helpful along with measurements of risk factors for evaluation of asymptomatic atherosclerotic disease.     

Impact of multiple cardiovascular risk factors on brachial artery distensibility in young adults: the Bogalusa Heart Study

BACKGROUND: Cardiovascular (CV) risk factors are associated with abnormalities in vascular function and structure. Arterial distensibility decreases with age and extent of arteriosclerosis. Mediators of arteriosclerosis may affect segments of the vascular tree differently, and information is limited on vascular changes of the brachial artery. Therefore, we explored the effect of multiple CV risk factors on brachial artery distensibility (BrachD). METHODS: A cross-sectional study of CV risk factors and BrachD was performed in an ongoing epidemiologic study (the Bogalusa Heart Study). Data were collected on 803 young adults (42% male, 72% white, aged 19 to 37 years) including BrachD measured by pulse waveform analysis (DynaPulse 2000A, Pulse Metric, Inc.) CV risk factors (anthropometric, hemodynamic, and metabolic variables) were considered abnormal if ranked in the highest age-, ethnicity-, and sex-specific quartile for this population (lowest quartile for HDL). RESULTS: BrachD was significantly lower in African American than in white subjects (6.33% v 6.76% Delta/mm Hg, P < .005). An inverse linear relationship was noted between BrachD and number of CV risk factors clustering in an individual (P < .0001 trend analysis). CONCLUSIONS: In young adults, increasing numbers of adverse CV risk factors is associated with decreased brachial artery distensibility. Noninvasive brachial artery function measures are useful in measuring subclinical arteriosclerotic vascular changes.     

Brachial artery distensibility and relation to cardiovascular risk factors in healthy young adults (The Bogalusa Heart Study)

Arterial distensibility decreases with age and atherosclerosis leading to increased pulse pressure (PP) and increased left ventricular work, resulting in left ventricular hypertrophy, a risk factor for cardiovascular morbidity. Brachial artery pulse curve data were collected using the DynaPulse 2000A. Distensibility measured in 920 healthy young adults (40% men, 70% white, age range 18 to 38 years) was compared with levels of cardiovascular risk factors. Laboratory, anthropometric, blood pressure (BP), and heart rate measurements were also obtained. Distensibility tended to decrease with age, reaching significance in women (p <0.05). Whites had greater distensibility adjusted for age than blacks, with women more than men (p <0.05). Distensibility adjusted for PP was negatively correlated with measures of body size, BP, glucose, insulin, low-density lipoprotein cholesterol, very low density lipoprotein cholesterol, and age (p <0.05). When distensibility was plotted as a function of PP to control for distending pressure, the lowest quintiles of systolic, diastolic, and mean arterial BPs tended to have greater distensibility. No differences were seen by quintiles of lipids. In multivariate analyses, BP, age, anthropometric measures, gender, and very low density lipoprotein cholesterol entered the model (r(2) = 0.56; p <0.02). Thus, brachial artery distensibility, which includes a normalization factor to control for body size, showed race and gender differences (whites and women had greater distensibility than blacks and men, respectively), even after adjustment for age. Stiffer vessels with decreased distensibility were seen in subjects with higher levels of cardiovascular risk factors across the range of normal PP. Therefore, noninvasive measures of distensibility are useful in measuring subclinical vascular changes related to arteriosclerosis.     

Framingham risk score is related to carotid artery intima-media thickness in both white and black young adults: the Bogalusa Heart Study

The Framingham risk score (FRS), developed in a white cohort aged 30-74 years, is increasingly used in the early risk identification for coronary artery disease (CAD). This study examines the relationship between FRS and carotid artery intima-media thickness (IMT), a surrogate marker of coronary atherosclerosis, in black and white individuals aged 20-37 years. Five hundred seventeen young adults (aged 20-37 years; 71% white, 39% male) enrolled in the Bogalusa Heart Study had carotid artery ultrasonography. Age, gender, systolic blood pressure, total cholesterol to HDL cholesterol ratio, cigarette smoking habit, type 2 diabetes, and left ventricular hypertrophy (LVH) were used to calculate FRS. Results indicated a significant, positive linear relationship between tertiles of FRS and IMT of the common, bulb, and internal carotid segments in blacks and whites alike. In a multivariate analysis including FRS, race, BMI, parental history of CAD, stroke, type 2 diabetes, or hypertension, logtriglycerides, loginsulin, alcohol consumption (ml/week), and regular physical activity, the FRS was independently associated with all three carotid segments. Further, the FRS as a main predictor variable explained relatively more of the variance in the IMT of the carotid bulb (9%) than in the common (5%) or internal (3%) carotid segments. These results support the use of FRS in both white and black young adults and underscore the importance of prevention and control of multiple risk factors in youth.     

Race (black-white) and gender divergences in the relationship of childhood cardiovascular risk factors to carotid artery intima-media thickness in adulthood: the Bogalusa Heart Study

It has been established that childhood cardiovascular (CV) risk factors are predictive of adulthood vascular changes as measured by carotid intima-media thickness (IMT). However, whether this relationship is race- and gender-specific is not known. This aspect was examined in a black-white cohort of 868 adults (29% blacks, 42% males) aged 25-44 years who were examined at least twice in childhood for traditional CV risk factors with an average follow-up period of 26.4 years. The average value of the two earliest childhood measurements was used as the childhood value, standardized to age, race, and gender-specific z-score. Carotid IMT was measured by B-mode ultrasonography. The mean of the maximum carotid IMT readings of three right and three left far walls for common, bulb and internal segments was used. In univariate analysis, significant correlates of adulthood carotid IMT (standardized to age-, race- and gender-specific z-score) were, in the order of decreasing magnitude, triglyceride and LDL cholesterol in white males; systolic blood pressure, LDL cholesterol, and body mass index (BMI) in white females; systolic blood pressure in black males; BMI and systolic blood pressure in black females. In multivariate regression analysis, significant predictors of carotid IMT were triglycerides and LDL cholesterol in white males; systolic blood pressure and LDL cholesterol in white females; systolic blood pressure in black males; and BMI and LDL cholesterol in black females. In conclusion, the predictability of childhood CV risk factors for increased carotid IMT in adulthood varies by race and gender. The prevention implications of these findings need further investigation.     

Adiponectin and its correlates of cardiovascular risk in young adults: the Bogalusa Heart Study

Adiponectin, a novel adipocytokine produced exclusively in the adipose tissue, plays a major role in the development of metabolic syndrome, type 2 diabetes mellitus, and related cardiovascular (CV) diseases. However, information is scant regarding the association of adiponectin with measures of CV risk in young adults. This aspect was examined in a biracial (black-white) community-based sample of 1153 individuals (mean age, 36.2 years; 70% white, 43% male) who participated in the Bogalusa Heart Study. Adiponectin levels showed race (white > black, P < .0001) and sex (female > male, P < .0001) differences, and correlated significantly in a beneficial manner to measures of obesity (body mass index, waist circumference, and abdominal height), mean arterial blood pressure, lipoprotein variables (low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides), measures of glucose homeostasis (insulin, glucose, homeostasis model assessment of insulin resistance [HOMA-IR]), and uric acid, after adjusting for age, race, sex, and cigarette smoking. In multivariate analysis that used either body mass index or abdominal height as a measure of general and visceral adiposity in 2 separate models, HOMA-IR was the major contributor explaining 18.4% and 18.1% of the variance, respectively. There was a significant interaction between abdominal height and HOMA-IR on adiponectin level in that the inverse association between adiponectin and insulin resistance was pronounced at higher level of visceral adiposity. Furthermore, adiponectin levels decreased with increasing number of metabolic syndrome risk factors defined by the National Cholesterol Education Program Adult Treatment Panel III (P for trend <.0001). Moreover, adiponectin levels were low among those with positive parental histories of coronary heart disease (P = .03), hypertension (P = .04), and type 2 diabetes mellitus (P = .01), considered as surrogate measures of risk. These findings, by showing an inverse association of adiponectin with insulin resistance, visceral adiposity, and related metabolic syndrome, and also with positive parental histories of coronary heart disease, hypertension, and type 2 diabetes mellitus, underscore the value of adiponectin in CV and type 2 diabetes mellitus risk assessments in young adults.     

Influence of nitric oxide synthase gene polymorphism (G894T) on carotid artery intima-media thickness in adults: the Bogalusa Heart Study

Nitric oxide generated by the vascular endothelial nitric oxide synthase (eNOS) plays an important role in the regulation of vascular structure/function and blood pressure. However, information is scant regarding the influence of G894T polymorphism of the eNOS gene on arterial wall thickness in asymptomatic young adults. This aspect was examined for G894T polymorphism in 661 White and Black subjects, aged 25 to 43 years (73.2% White; 39.5% male). Arterial vascular changes were assessed by common carotid intima-media thickness (IMT) using B-mode ultrasonography. The variant T allele frequency of G894T was significantly higher in Whites compared with Blacks (0.339 vs. 0.102; P < .0001). In bivariate analysis, adjusted for gender, age, mean arterial blood pressure, and/or race, carotid IMT was marginally lower in carriers vs. non-carriers of T allele in Whites (P = .07), but significantly lower for the total number of subjects (P = .04). In multivariable regression analysis, adjusted for gender, age, mean arterial pressure, body mass index (BMI), low-density lipoprotein cholesterol, triglycerides/high-density lipoprotein cholesterol ratio, homeostasis model assessment of insulin resistance, smoking, and race (in the total sample), the variant allele was independently associated with lower carotid IMT in both the White subjects (P = .04), and total sample (P = .03). These results suggest that the allelic variation of G894T polymorphism of the eNOS gene beneficially influences vascular changes as measured by carotid IMT in asymptomatic young adults.     

Vascular abnormalities in asymptomatic, healthy young adult smokers without other major cardiovascular risk factors: the Bogalusa Heart Study

Cigarette smoking, an established cardiovascular (CV) disease risk factor, is known to impair pulsatile arterial function in middle-aged and older adults. However, information is scant in healthy young adults for whom smoking is the only CV risk factor, at current guidelines. Nonsmokers (n = 145) and smokers (n = 142) aged on average 36 years were selected for not having obesity, hypertension, dyslipidemia, diabetes, or clinically manifest CV disease. Pulsatile arterial function was measured in terms of large artery compliance (C1), small artery compliance (C2), and systemic vascular resistance (SVR) by noninvasively recorded radial artery waveforms. Smokers versus nonsmokers had significantly lower measures of adiposity and LDL-cholesterol; and higher systolic blood pressure and triglycerides. In addition, smokers versus nonsmokers had lower C2 (5.09 v 6.63 mL/mm Hg x 100, P = .0009) and higher SVR (1399.0 v 1325.5 dyn . sec . cm(-5), P = .006), after adjustment for race, sex, and age. Decreases in C2 (P for trend = .001) and increases in SVR (P for trend = .01) were noted with increasing years of smoking. Multivariate analysis revealed that duration of smoking was associated adversely with C2 (P = .004), independent of race, sex, age, systolic and diastolic blood pressures, HDL-cholesterol, triglycerides, glucose, and insulin. The odds of having adverse C2 (bottom 10 percentile) and SVR (top 10 percentile) were, respectively, 2.9 (P = .01) and 2.6 (P = .07) times higher in smokers versus nonsmokers. The observed deleterious effects of cigarette smoking on arterial wall dynamics in otherwise healthy young adults underscore the need for aggressive early prevention and intervention strategies to control smoking behavior.     

Interaction of G-protein beta3 subunit and nitric oxide synthase gene polymorphisms on carotid artery intima-media thickness in young adults: the Bogalusa Heart Study

BACKGROUND: G-protein beta3 subunit (GNB3) gene C825T and endothelial nitric oxide (eNOS) gene G894T polymorphisms both influence arterial structure and function. However, information is scant regarding the interaction of these genes on arterial wall thickness. METHODS: This aspect was examined in 654 white and black subjects, aged 25-43 years (72.9% white, 39.3% male). Arterial wall thickness was assessed in terms of the average intima-media thickness (IMT) of common carotid, internal carotid, and carotid bulb segments by B-mode ultrasonography. RESULTS: Frequencies of T allele of the GNB3 C825T polymorphism (0.718 vs. 0.304, P < 0.0001) and G allele of the eNOS G894T polymorphism (0.868 vs. 0.661, P < 0.0001) were higher in blacks compared to whites. In a multivariate model including gender, age, mean arterial pressure, body mass index, triglycerides/HDL cholesterol ratio, insulin resistance index, smoking, and/or race, there was no significant genotypic effect on carotid IMT with respect to GNB3 C825T or eNOS G894T polymorphisms among whites, blacks, and total sample. However, the carriers of TT genotype of the GNB3 C825T and T allele of the eNOS G894T had a significantly lower carotid IMT among blacks (P = 0.003) and the total sample (P = 0.006). CONCLUSION: These results indicate that the genetic variations of the eNOS gene in combination with the GNB3 gene jointly influence carotid artery wall thickening process in young adults, especially in blacks.     

Coronary artery calcium versus intima-media thickness as a measure of cardiovascular disease among asymptomatic adults (from the Rancho Bernardo Study)

Detection and quantification of subclinical coronary heart disease by noninvasive imaging techniques offers the potential for earlier diagnosis with targeted prevention and therapy. This study, designed to determine the extent to which carotid artery intima-media thickness (IMT) predicts coronary artery calcium (CAC) in asymptomatic older adults, included 141 men and 137 women > or =55 years of age with no previous coronary heart disease who had B-mode ultrasound of the common and/or internal carotid arteries in 1997 to 1999 to measure IMT and electron beam computed tomographic scanning in 2001 to 2002 to measure CAC score. Overall, 29% of participants had a severe plaque burden (CAC score >400); 50% of these had a CAC score >800. IMT of the common and internal carotid arteries was significantly associated with the CAC score measured an average of 3 years later. The ability to correctly identify subjects with a severe CAC score (sensitivity) was 50% to 60% for an IMT of the internal or common carotid artery > 80th percentile (internal carotid IMT > or =1.9 mm and common carotid IMT > or =1.04 mm). Specificity, the ability to correctly identify those who did not have a severe CAC score (> or =400), was approximately 75%. In conclusion, IMT of the carotid arteries predicted the severity of CAC burden an average of 3 years later in community-dwelling asymptomatic older adults.     

High-resolution radial artery intima-media thickness and cardiovascular risk factors in patients with suspected coronary artery disease--comparison with common carotid artery intima-media thickness

ObjectiveThe radial artery wall structure can be measured with non-invasive very high-resolution ultrasound with great feasibility and high accuracy. In the present study, we aim to explore clinical correlates of radial artery intima-media thickness (rIMT), in a relatively large patient cohort with suspected coronary artery disease, and further compare those to common carotid artery IMT (cIMT) that is an accepted surrogate marker of atherosclerosis.MethodsFour hundred and sixteen patients referred to myocardial perfusion scintigram (MPS) were recruited, and cIMT and rIMT were scanned using conventional and very high-resolution ultrasound (55 MHz transducer), respectively. A number of plasma biomarkers were also measured.ResultsBoth cIMT and rIMT were similarly correlated with disease history, MPS-verified ischemia, carotid plaque burden, and lipid status. Repeated measurement of rIMT showed acceptable variability.ConclusionRadial artery IMT may constitute a novel feasible imaging biomarker for systemic atherosclerosis burden, which may be used in future imaging trials to evaluate, e.g. anti-atherosclerotic treatments.     

Correlates of carotid artery stiffness in young adults: The Bogalusa Heart Study

Decreased arterial elasticity, an independent risk factor for cardiovascular (C-V) disease, is associated with C-V risk factors in middle-aged and older individuals. However, information is limited in this regard in young adults. This aspect was examined in a community-based sample of 516 black and white subjects aged 25-38 years (71% white, 39% male). The common carotid artery elasticity was measured from M-mode ultrasonography as Peterson's elastic modulus (Ep) and relative wall thickness-adjusted Young's elastic modulus (YEM). Blacks and males had higher Ep (P < 0.05); males had higher YEM (P < 0.0001); and blacks had higher wall thickness (P < 0.01). For the entire sample adjusted for race and gender both Ep and YEM correlated significantly (P < 0.05-0.0001) with age, BMI, waist, systolic and diastolic blood pressures, heart rate, product of heart rate and pulse pressure, triglycerides, total cholesterol to HDL cholesterol ratio, insulin and glucose. In a multivariate regression model that included hemodynamic variables, systolic blood pressure, product of heart rate and pulse pressure, age, triglycerides, BMI, and male gender (for YEM only) were independent correlates of Ep (R2 = 0.38) and YEM (R2 = 0.25). When the hemodynamic variables were excluded from the model, age, triglycerides, BMI, black race (Ep only), male gender, parental history of hypertension, HDL cholesterol (inverse association), and insulin (marginal significance) remained independent correlates of Ep (R2 = 0.20) and YEM (R2 = 16). Both Ep and YEM increased (P for trend P < 0.0001) with increasing number of independent continuous risk factors (defined as values above or below the age, race, and gender-specific extreme quintiles) that were retained in the regression models. The observed increasing arterial stiffness (or decreased elasticity) with increasing number of risk factors related to insulin resistance syndrome in free-living, asymptomatic young adults has important implications for prevention.     

Effect of parental coronary artery disease on adverse effects of the metabolic syndrome and aging on carotid artery intima-media thickness (from the Bogalusa Heart Study)

Genetic susceptibility is considered an important predictor of coronary artery disease (CAD) and its risk factors. This study was conducted to assess the hypothesis that parental CAD, a surrogate measure of genetic susceptibility, increases the vulnerability of the arterial wall to adverse effects of the metabolic syndrome and the aging process in asymptomatic young adults. The study cohort consisted of 1,073 black and white subjects (29.1% black, 43.7% male) aged 25 to 44 years. Carotid intima-media thickness (IMT) of the common carotid, carotid bulb, and internal carotid segments was measured using B-mode ultrasound. Subjects with parental CAD had greater composite (average of 3 segments) carotid IMT (0.839 vs 0.802 mm, p = 0.04) and a higher prevalence of the metabolic syndrome (20.7% vs 13.3%, p <0.01) compared with those without such a history. Furthermore, the association of the metabolic syndrome with composite, carotid bulb, and internal carotid IMT was significantly stronger in subjects with parental CAD than those without such a history (p = 0.022, p = 0.032, and p = 0.035 for comparison of slopes, respectively). After adjusting for race, gender, and the metabolic syndrome components, only internal carotid IMT showed significantly more increase with age in subjects with parental CAD compared with those without such a history (regression coefficient: beta = 0.014 vs beta = 0.006, p = 0.010 for comparison of slopes). In conclusion, parental CAD amplifies the adverse effects of the metabolic syndrome and aging on carotid artery IMT, especially internal carotid IMT, in asymptomatic young adults. These findings reinforce the value of using family history of CAD in risk assessment algorithm.     

Influence of persistent obesity in children on cardiovascular risk factors: the Bogalusa Heart Study

The relationship between body fat indexes, lipid and lipoprotein levels, and blood pressure was studied in 2230 children, each examined during 1973, 1976, and 1978. The children were grouped with the use of seven percentile (P) intervals of triceps skinfold thickness that were specific for race, sex, and age; cardiovascular risk factor variables were assessed over time. Of the 238 children initially in the lowest P group (less than 15P), 44% remained there, and 65% had skinfold thicknesses below 30P on the three occasions. Of the 352 children in the highest P group (greater than or equal to 85P), who were considered to be very obese, 39% remained at this level while 69% remained at 70P or greater. Of the 366 considered to be obese (greater than or equal to 70, less than 85%P), 38% remained at or above 70P. At baseline, children in the seven groups differed in weight, ponderosity (wt/ht3), systolic and diastolic blood pressures, serum triglyceride levels, and pre-beta- and beta-lipoprotein cholesterol levels. Pairwise comparison of data from children in each of the six other groups with those from children in the middle range (greater than or equal to 40, less than 60P) showed that the obese and very obese children had significantly higher systolic blood pressures (p less than .05), while only those in the highest P group had significantly greater diastolic blood pressures (p less than .05). These differences increased and diverged over time. Those in the obese and very obese groups showed a striking drop over time in alpha-lipoprotein cholesterol levels and increases in pre-beta-lipoprotein cholesterol levels and systolic blood pressure. Triglyceride levels decreased over time for the lowest and middle range groups but remained at higher levels in obese and very obese children. There was a strong tendency for tracking (remaining in the same P group over time) in lean, obese, and very obese children. Those who tracked showed definite differences in risk factor variables at the baseline level and over time when compared with the middle range group. Since consistent obesity in early life enhances cardiovascular risk, the measurement over time of skinfold thickness in children is a useful method to detect the potential for adult cardiovascular disease.     

Distribution and cardiovascular risk correlates of serum triglycerides in young adults from a biracial community: the Bogalusa Heart Study

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 (white>black) and sex (male>female) 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.     

Predictors of left ventricular dilatation in young adults (from the Bogalusa Heart Study)

Left ventricular (LV) dilatation may be an early sign of cardiac decompensation progressing to LV dysfunction. Determinants of LV dilatation in young asymptomatic adults are unknown. Five hundred six asymptomatic subjects (mean age 32 +/- 3 years) enrolled in the Bogalusa Heart Study underwent echocardiographic examination. LV dilatation (LV end-diastolic diameter >5.5 cm) as measured by M-mode echocardiography was found in 31 subjects (6%). Subjects with LV dilatation had greater body mass indexes (32 +/- 9 vs 27 +/- 6 kg/m2, p <0.0001), systolic (119 +/- 15 vs 112 +/- 12 mm Hg, p = 0.007) and diastolic (79 +/- 12 vs 75 +/- 9 mm Hg, p = 0.04) blood pressures, and LV mass (230 +/- 50 vs 123 +/- 39 g, p <0.0001). Age, gender, race, and metabolic parameters (glucose, insulin, and lipoprotein levels) did not differ significantly between the subjects with and without LV dilatation. After correction for age, gender, and race differences, adulthood obesity (body mass index >30 kg/m2) was associated with a threefold odds ratio (2.9, 95% confidence interval 1.4 to 6.1), and hypertension (defined as per the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) was also associated with a threefold odds ratio (3.0, 95% confidence interval 1.2 to 7.1) for an increased incidence of LV dilatation. There was an incremental increase in LV end-diastolic dimension depending on the presence of hypertension or obesity, and subjects with obesity and hypertension in adulthood had the greatest degree of LV end-diastolic dimensions. In multiple regression analyses, body mass index in childhood was the only significant predictor of LV dilatation in adulthood (odds ratio 1.47, 95% confidence interval 1.03 to 2.09). In conclusion, obesity beginning in childhood and obesity and hypertension in young adulthood are predictors of LV dilatation in an otherwise healthy young adult population.