The atherosclerotic process begins in childhood with the appearance of fatty streaks in the distal abdominal aorta and later affects the carotid and coronary arteries. Identification of children and adolescents at high risk for atherosclerosis would allow early intervention before the development of symptoms. Measurement of carotid intimal-medial thickness (IMT) detects subclinical disease and is predictive of coronary artery disease, stroke and peripheral vascular disease in older adults. In 1970, cardiovascular risk factors (CRF) were measured in school age children in Muscatine, Iowa. A representative sample of 675 members of this initial cohort are now aged 42 to 50 years. Risk factors were measured in childhood, young adulthood, and three times as older adults. In addition, measures of subclinical disease including carotid IMT, coronary artery calcification (CAC) and brachial artery flow-mediated dilatation have been completed. Carotid IMT in young and middle-aged adults is related to childhood risk factors including cholesterol in both genders and obesity in women. Carotid IMT is significantly associated with CAC and current CRF. In 442 of the offspring of this cohort, aged 15 to 30 years, carotid IMT is not related to CRF but CRF in the offspring are related to parental carotid IMT. Carotid IMT is correlated within siblings and with parental IMT suggesting that there is familial aggregation of carotid IMT. In this application, we will measure IMT in a vascular bed affected earlier by atherosclerosis, the distal abdominal aorta, as well as in the carotid artery. In 662 offspring, aged 11 to 32 years, we will determine (1) if aortic and carotid IMT are related (2) the relationship of CRF to aortic IMT and progression of carotid IMT and (3) the relationship of aortic and carotid IMT in the offspring to subclinical (as measured by progression of carotid IMT) or clinical (cardiovascular morbidity or mortality) disease in their parents. This proposal has the potential of providing information which would allow identification of individuals at high risk of atherosclerosis during childhood or adolescence.
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