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Heart Beat

Bogalusa's Big Heart

The Bogalusa Heart Study has yielded invaluable insight into cardiovascular risk factors and how we can prevent them.

Bogalusa and Kids

Observations from the Bogalusa Heart Study present a powerful argument for rethinking the American child's diet.
• The major causes of adult heart disease, atherosclerosis, coronary heart disease, and essential hypertension begin in childhood: documented changes occur by five to eight years of age.
• Cardiovascular risk factors can be identified in early life.
• Autopsy studies show lesions in the aorta, coronary vessels, and kidney relate strongly to clinical cardiovascular risk factors, clearly indicating that atherosclerosis and hypertension begin in early life.
• Environmental factors are significant and influence dyslipidemia, hypertension, and obesity.
• Because lifestyles and behaviors influencing cardiovascular risk are learned and begin early in life, healthy lifestyles should be adopted in childhood--they are critical to modulation of risk factors later in life. Primary-care physicians and pediatricians can play a major leadership role in the prevention of adult heart diseases beginning in childhood. Physicians are encouraged to obtain risk-factor profiles on children, along with a family history of heart disease.

By Patrick Perry

From the January/February 2004 Issue

We owe a lot to the residents of the small community of Bogalusa, Louisiana, and a dedicated physician whose work has greatly advanced our knowledge about the natural history of heart disease and hypertension. For over three decades, renowned cardiologist Gerald Berenson and his team of researchers have conducted the world's longest-running study of cardiovascular risk factors in children, adolescents, and young adults living in a diverse, free-standing, and biracial community. And in the process, the Bogalusa Heart Study has yielded invaluable insights into risk factors now considered common knowledge.

"We have an unprecedented wealth of knowledge about the lifestyle, dietary habits, and cardiovascular risk factors of this population," noted Dr. Berenson, director of the Tulane Center for Cardiovascular Health and founder of the study. "Very clearly, adult heart disease, hypertension, type 2 diabetes, and obesity begin in childhood. We know how to study risk factors in children, and we have an understanding that lifestyles begin in childhood. Most of all, we've learned the importance of prevention. As the majority of the population grows older, study of the aging process and longevity becomes increasingly important from a public-health perspective."

In 1972, with funding from the National Heart, Lung, and Blood Institute of the NIH, Berenson's team began tracking the health histories of the over 17,000 children and young adults who have become part of the study. Using a multidisciplinary approach, researchers began analyzing blood samples, measuring blood pressure, assessing height and weight, and interviewing the children and parents about food and lifestyle choices--yielding a vast treasure of data that have been included in over 700 publications and numerous books.

"Our initial study screened about 4,000 children to age 14," Berenson says. "We found high cholesterol levels even in preschool children. The object of this project was to study all the kids that we could in Bogalusa to make a complete community study--one of only two in the country that I am aware of. What makes Bogalusa unique is that we have a biracial community, with 35 percent African-American participants. Thirty years ago, we knew that there were gender and racial contrasts, and our study now supports that finding. The African-American population tends to have higher blood pressure and diabetes, while young to middle-aged white men tend to express early coronary disease."

Dr. Berenson's findings prove even more relevant today in light of the dramatic increase in obesity among youth and adults. While many adults believe overweight children are simply passing through a "phase" and will eventually outgrow youthful obesity, studies suggest a much different conclusion. Bogalusa researchers have found evidence of coronary heart disease and arteriosclerosis in very young children. Unfortunately, early patterns tend to persist throughout life. Of importance, risk factors like obesity, bad cholesterol (LDL), and even high blood pressure are predictive of adult levels.

"Looking at height and weight, we see that overweight children tend to be obese in adulthood," Dr. Berenson explains. "The message from Bogalusa is: our population has an epidemic of obesity, an epidemic of coronary artery disease. Kids are getting fatter, and there is much less exercise. Much of it relates to the pace of modern society, the availability of food, changes in diet, and increased inactivity."

The ongoing study also demonstrates that risk factors emerge in groups, leading to more serious chronic diseases later in life. "Multiple risk factors tend to cluster and reinforce themselves," Berenson notes. "High LDL (bad) cholesterol levels, high triglycerides, low HDL (good) cholesterol, and obesity are risk factors that we have found elevated in the youth population. These relate to abnormally high insulin levels and more adult-onset diabetes. The best way to approach the issue is through education and prevention."

More recently, the Bogalusa Heart Study is exploring the role of genetics and environment in the development of chronic cardiovascular disease.

"We are looking at genetic and environmental interactions," Berenson says. "We are studying the dickens out of our population base, trying to explain what genetic markers are associated with high blood pressure or obesity, for example."

A longtime advocate for early intervention and prevention, Dr. Berenson's research underscores the role that lifestyle and behavior, such as poor diet and sedentary lifestyle, play in disease. Adopted within a child's first few years of life, food and exercise choices dramatically influence cardiovascular risk later in life. Berenson's team developed an innovative program called Health Ahead/Heart Smart to teach healthy behaviors to youth.

"Health Ahead/Heart Smart is a comprehensive initiative," the cardiologist explains. "We address the entire school environment--lifestyle changes for teachers, changes in the cafeteria, and an increase in physical activity for all kids on the school grounds. The program includes 75 noncompetitive exercises. We also get parents and the community involved with newsletters and health fairs. For example, we have simulated fun runs across the country that celebrate areas of historic interest. Along the way, students can talk about the geography of special areas, and we integrate mathematics with heart and pulse rates. The thrust of the program is behavioral orientation, starting in kindergarten."

The program includes instruction for food-service workers, teachers, children and their families concerning low-fat food preparation, healthy eating, exercise, self-esteem, and the importance of avoiding risky habits such as smoking and drinking alcohol.

To learn more about Health Ahead/Heart Smart, write The Tulane Center for Cardiovascular Health, SL29 1430 Tulane Avenue, New Orleans, LA 70112-2699 or e-mail Dr. Berenson at berenson@tulane.edu.

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