Can adults at high-risk of cardiovascular disease be identified by screening their children for risk factors?


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Abstract

SYNOPSISBACKGROUNDMany cardiovascular disease (CVD) processes begin in childhood, but neither children nor middle-aged adults undergo routine screening. Previous studies indicate a link between the presence of cardiovascular risk factors in children and the presence of the same risk factors in their parents. Primary care could, therefore, provide an opportunity to identify both children and parents at high risk for CVD.OBJECTIVETo investigate whether primary-care evaluation of cardiovascular risk factors in children can help identify parents at increased risk of CVD.DESIGN AND INTERVENTIONThis community-based study recruited participants through education and screening programs carried out by academic, community, and religious institutions in Pittsburgh, PA, USA. From October 2003 to June 2005, families consisting of at least one child (5-17 years of age) and at least one biological parent (18-75 years of age) were enrolled. Exclusion criteria included cancer, connective tissue disorders, or pregnancy in parents or children. Participants were required to fast for a minimum of 8 h before their single study visit, which involved all parents and children undergoing measurement of height, weight, waist circumference (umbilicus level), blood pressure, calculation of BMI, and finger-prick blood measurement of HDL-cholesterol, LDL-cholesterol, triglycerides, and glucose.OUTCOME MEASURESIncidence of obesity, dyslipdemia, hyperglycemia, hypertension, and the metabolic syndrome (MetS) in parents and children enrolled in the study.RESULTSIn total, 108 parents and 141 children from 94 families participated in the study. Eighty single-parent families were enrolled, of which four were father-only. Overall, 170 child-parent pairs were available for analysis. The children had a mean age of 10.5 years, with 31% being of white ethnic origin and 60% being male. Current smoking was reported in 4% of children and 24% of parents. Hypertension was recorded in 6% of children and 22% of parents. In addition, 40% of children and 57% of their parents were classified as obese, and the MetS was diagnosed in 8% of children and 28% of adults. In both parents and children, the most prevalent sign of the MetS was large waist circumference. Several risk factors demonstrated strong child-parent associations. Parents of children with a BMI in the 95th percentile were significantly more likely to have a high BMI themselves than parents of children with lower BMIs (adjusted odds ratio (OR) 5.97, 95% CI 2.50-14.24; P<0.0001). Similarly, parents of children with high blood pressure were highly likely to be hypertensive (adjusted OR 14.7, 95% CI 3.02-71.56; P = 0.0009), and high triglyceride levels in children (≥110 mg/dl) were significantly correlated with high triglyceride levels in their parents (adjusted OR 4.89, 95% CI 2.10-11.37; P = 0.0002). By contrast, HDL-cholesterol, LDL-cholesterol and glucose levels, and the MetS were not significantly correlated between children and their parents.CONCLUSIONSeveral cardiovascular risk factors present in children significantly predict the presence of the same risk factor in their parents.

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