CARDIAC

Abstract

The dramatic increase in childhood obesity in recent decades highlights the importance of public health efforts to be focused on both risk factor surveillance and prevention. PURPOSE: With its inception in 1998, the Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project was developed to detect obesity and other risk factors of heart disease and Type II diabetes among fifth grade children in rural West Virginia. METHODS: Risk factors assessed through school-based screening include: body mass index (BMI), total cholesterol (TC), low-density lipoprotein, high-density lipoprotein, triglycerides (TG), family history of both heart disease and type II diabetes. Children were also screened for the presence of acanthosis nigricans (AN), when present fasting insulin (INS) levels was measured. To date over 40,000 children have participated in the CARDIAC Project. A complete lipid profile has been completed on 13,673 children (mean age 10.97 years, 7072 girls). RESULTS: Forty-five percent were at-risk for or overweight (body mass index (BMI) greater than the 85th percentile for gender and age),12.9% had high TC, 16.4% had low HDL, 10.5% had high LDL, and 13.0% had high TG. Family history (FHX) indicated that 49.0% had a positive FHX for heart disease and 51.6% had a positive FHX for diabetes. 5.2% were positive for AN, and 37% of those with AN had abnormal INS. There were significantly more boys who were classified as at-risk or overweight, and they had higher TC, LDL, and TG (p<0001), as well as higher HDL (p<001) than the girls. When comparing normal weight to at-risk or overweight children, normal weight children had lower (p<001) TC, LDL, TG and higher (p<001) HDL. When comparing the at-risk for overweight to the overweight children, the overweight children had (p<001) worse lipid values (TC, LDL, TG and HDL) than those at risk. CONCLUSIONS: Results from the CARDIAC Project have initiated the development of both population-based and high-risk interventions throughout the state. These alarming results have also been instrumental in the development of several policies targeting increased physical activity and better nutrition in the school setting.