Bogalusa Heart Study

BACKGROUND:

The Bogalusa Heart Study has been a long-term epidemiologic study. The investigators have
identified and followed black and white participants for nearly 40 years, and have described
the incidence and prevalence of biologic and behavioral cardiovascular disease risk factors
from childhood through adulthood. Their participation has enabled the study to not only
document differences between males and females, but also between blacks and whites. The
results from the Bogalusa Heart Study have clearly documented that the genesis of
atherosclerosis has its basis in childhood, and that prevention can and must begin at the
early ages.

The Bogalusa Heart Study had been funded over the years by the Specialized Centers of
Research (SCOR) Program. The SCOR program was initiated by NHLBI in 1970 to expedite the
development and application of new knowledge essential for improved diagnosis, treatment, and
prevention of arteriosclerosis, hypertension, pulmonary disease, and thrombosis. In 1984 a
Demonstration and Education Component was added to the parent SCOR of the Bogalusa Heart
Study in order to translate the experience gained in epidemiological studies into an
intervention study designed to retard the development of cardiovascular risk factors in
children. Beginning in 1987, the Bogalusa Heart Study was supported by a regular research
grant. Beginning in 1997, the study is supported by the cooperative agreement mechanism.

DESIGN :

The initial survey in 1973-1974 was restricted to children ages 2 1/2 to 14. A physical
examination was conducted and information was collected on anthropometric data, hemoglobin,
blood pressure, serum lipids, and health history. Over 3,500 children participated. The
second cross-sectional survey of 1976-1977 and subsequent surveys expanded the eligible
population to include all children ages 5-17 years. The second survey of over 4,000 children
also included information on salt intake, smoking, health beliefs, and attitudes, and for
girls ages 8-17, menstrual history and oral contraceptive use. The third survey of over 3,500
participants in 1978-1979 also collected anthropometric measurements on skinfold thickness
and two measurements of heart rate. The fourth survey of over 3,300 participants in 1981-1982
added data on alcohol use, Type A behavior, peer networks and dieting habits.

The Bogalusa Heart Study continued to use a cross-sectional and longitudinal design with the
general cross-sectional survey of approximately 3,700 Bogalusa children ages five to
seventeen in 1988-1989 in the sixth screen and additional longitudinal studies to recall
children in defined subgroups for more intensive evaluation. Half of the 12,000 participants
screened since 1973 had been studied three or more times. There were several other cohort
groups and studies. The Newborn-Infant Cohort Study was designed to describe distributions,
inter-relationships, and trends through time for blood pressure, serum lipid and lipoprotein
concentrations, dietary intake patterns, and anthropometric measurements. Four hundred and
forty infants born between January 1, 1974 through June 30, 1975 were examined at birth, at
six months, and yearly at ages one through four and at seven, ten and thirteen years for
cardiovascular risk factor variables. The Post High School Study examined young adults ages
21 through 30 who previously were examined as children ages five through fourteen in the
first Bogalusa Heart Study screening in 1973-1974. The population included approximately
4,603 young adults originally screened and any other children or adolescents examined for the
first time in any subsequent surveys.

The fifth screening began in 1988 and extended through December 1991. The Pediatric Pathology
Risk Factor Program, which began in 1978, documented the relationship of cardiovascular
disease risk factors to anatomic and pathologic changes. A local information system was
established to obtain family or coroner's consent to autopsy any deceased resident between
the ages of three and 26 in the Bogalusa area. Autopsy specimens were collected from over 100
deceased children and young adults, of whom approximately forty percent had been previously
examined in the Bogalusa Heart Study.

Major activity during 1988-1991 involved 24-hour dietary recall collections on all the 1963,
1966, and 1968 birth cohorts attending the Post High School Study. A food frequency
questionnaire was also self-administered to all the Post High School Study participants. The
use of these two dietary methodologies, 24-hour dietary recall and food frequency
questionnaire, provided data to assess the nutrient composition of diets of young adults,
assess the weekly consumption of individual foods, compare nutrient composition data with
food frequency data, and compare dietary intakes at the post high school age with those of
school age. Several substudies were conducted using the Bogalusa Heart Study population.
Among them were the impact of childhood obesity on risk factors, the relationship of
apolipoproteins A-I and B in children to parental myocardial infarction and the relationship
between left ventricular size as demonstrated by echocardiography and blood pressure
distribution.

The study was renewed in Fiscal Year 1992 in order to follow-up the previously examined young
adults for development of abnormal levels of cardiovascular risk factors and even clinical
disease.

In 1997, the study was renewed and extended through 2002, and from 2002-2010, and again in
2012 in order to study the impact of genetic factors on the evolution from childhood
cardiovascular risk factors to subclinical and clinical morbidity in an adult population,
ages 20 to 43, who had been followed over a long period of time. The study also seeks to
study the association of risk factor phenotypes to anatomic changes in the cardiovascular
system as seen by necropsy. The population for genotype-phenotype studies includes
approximately 1,400 siblings derived from longitudinal birth cohorts.

The cardiovascular phenotypes include obesity, blood pressure, lipids, lipoproteins,
apoproteins, homocysteine, glucose-insulin, fibrinogen, plasminogen activator inhibitor-1 and
von Willebrand Factor. Environmental risk factors consist of sociodemographic
characteristics, tobacco and alcohol use, oral contraception, physical activity, cognitive
and physical function, and quality of sleep and diet. Subclinical morbidity includes
echo-Doppler measurements of cardiac-carotid structure and function. Using robust sibling
pair linkage methods, a genome-wide search involving 391 markers with spacing of 10
centimorgans is conducted for genes which influence quantitative traits. This is supplemented
with 41 highly polymorphic markers located in or near candidate genes likely to be related to
obesity, lipoprotein metabolism, blood pressure, insulin resistance, diabetes, atherogenesis
and thrombosis.

Approximately 75 percent of the dollars of a Specialized Center of Research (SCOR) in
Arteriosclerosis (P50HL14103) were used to support the Bogalusa Heart Study from 1972 through
1986.

Since 2002, the study has been supported by the National Institute on Aging (NIA), the
National Heart, Lung, and Blood Institute (NHLBI), the National Institute of Environmental
Health Sciences (NIEHS), and the National Institute of Child Health and Human Development
(NICHD).

All previous participants of the Bogalusa Heart Study.