Epidemiology of early cardiovascular disease: Observations from the Bogalusa heart study

Cardiovascular risk factors associated with underlying coronary artery and hypertensive disease develop during childhood. Race- and sex-specific observations from childhood to young adulthood provide clues to the clinical presentation of cardiovascular disease risk later in life. Of particular interest are observations on distributions of levels, tracking, and determinants of lipoproteins and blood pressure, and the impact of obesity on cardiovascular risk during transition periods of growth and maturation. Mean levels of serum lipids and lipoproteins reach adult levels by 2 years of age. After a slight decline during puberty, low-density lipoprotein cholesterol (LDL-C) rises rapidly in young adulthood while high-density lipoprotein cholesterol (HDL-C) declines during adolescence to reach adult levels, particularly for White males. Both systolic and diastolic blood pressures tend to increase with growth until adult stature is reached with somewhat higher levels seen in Blacks. Significant consistency in ranks over time (tracking) is noted. The single best predictor of young adult levels is the level during childhood. Obesity and lifestyles influence lipoprotein levels early in life with risk factor variables clustering just as in adults. Autopsy studies reveal a significant relation of coronary artery lesions to adverse lipoprotein profiles, blood pressure and obesity, especially in males, underlying the importance of multiple risk factors. These observations emphasize the need for developing preventive approaches to adult cardiovascular disease beginning in childhood. © 1993 Wiley-Liss, Inc.