Familial Aggregation of Cardiovascular Disease Risk Factors: The Cuenca Study

doi:10.1006/pmed.1998.0394

Preventive Medicine

Volume 28, Issue 2, February 1999, Pages 131-137

https://doi.org/10.1006/pmed.1998.0394 Get rights and content

Abstract

Objective.The familial aggregation of lipid levels, blood pressure, and body mass index (BMI) was studied in schoolchildren in Cuenca, Spain.

Methods.A cross-sectional observation study was made of 307 schoolchildren of both sexes, age range 9-12 years, from three schools in Cuenca, Spain, and of 346 parents. Social and demographic variables, weight, height, body mass index, systolic blood pressure, diastolic blood pressure, and fasting plasma concentrations of total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglycerides were evaluated.

Results.The Spearman coefficients of correlation for total cholesterol, LDL-cholesterol, and BMI for parents and daughters were 0.34-0.42 (P< 0.01). These coefficients of correlation for parents and sons were lower (P> 0.05). The coefficient of correlation for blood pressure in parents and sons was low (P< 0.05). None of the variables showed any coefficient of correlation between spouses. The sexual differences in the correlations between the levels of the different variables were confirmed by multiple regression analysis. Total cholesterol and LDL-cholesterol levels and BMI accounted for larger percentages of variability in these parameters in daughters than in sons. The paternofilial aggregation of HDL-cholesterol and triglyceride levels was weak. The only variable that accounted for a significant variability in blood pressure (systolic and diastolic) was weight in children of both sexes.

Conclusions.The familial aggregation of lipid levels and body mass index showed sex differences. The paternofilial aggregation of blood pressure was weak. There was no relation between spouses.

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Cited by (14)

Environmental factors, familial aggregation and heritability of total cholesterol, low density lipoprotein-cholesterol and high density lipoprotein-cholesterol in a Brazilian population assisted by the Family Doctor Program
2011, Public Health
Citation Excerpt :
For TC and LDL-C, correlation was higher among mothers and offspring than among fathers and offspring. Other authors also found higher correlation between female pairs.20–22 A likely explanation for the higher correlation between mothers and offspring in relation to fathers is the mitochondrial inheritance.
To estimate familial aggregation and the heritability of total cholesterol (TC), low density lipoprotein-cholesterol (LDL-C) and high density lipoprotein-cholesterol (HDL-C) in families assisted by the Family Doctor Program in a Brazilian city, and to evaluate associations between some environmental factors and familial aggregation of these lipids.
Cross-sectional familial study.
The association of lipids with sociodemographic factors, lifestyle factors and comorbidities (e.g. physical activity, alcohol consumption, smoking, hypertension, impaired glucose tolerance, body mass index) was estimated using linear models and generalized estimating equations. Correlation of TC, LDL-C and HDL-C between pairs of relatives was estimated with the familial correlation procedure, and heritability was estimated with the ASSOC procedure.
All associations were statistically significant. There was familial aggregation of TC (parent/offspring, r = 0.33; sibling/sibling, r = 0.37), LDL-C (parent/offspring, r = 0.29; sibling/sibling, r = 0.37) and HDL-C (parent/offspring, r = 0.25; sibling/sibling, r = 0.48), but less than 3%, 6% and 14%, respectively, which was explained by lifestyle factors. Correlation between pairs with genetic sharing (parent/offspring and sibling/sibling) was higher than that observed between father and mother. Heritability estimates ranged between 0.32 (HDL-C) and 0.50 (TC). Similar results were found for the two approaches used to estimate the contribution of genetic and environmental factors in the correlation of TC, LDL-C and HDL-C between the family pairs.
The results showed that there is familial aggregation of TC, LDL-C and HDL-C, and point to the predominance of genetic factors because little influence of environmental variables was found.
Prevalence of obesity and trends in cardiovascular risk factors among Spanish school children, 1992-2004: The Cuenca (Spain) study
2006, Medicina Clinica
El propósito del presente estudio ha sido estimar la prevalencia de sobrepeso y obesidad en escolares de la provincia de Cuenca en el año 2004, así como examinar los cambios del índice de masa corporal (IMC), presión arterial sistólica (PAS) y diastólica (PAD) y lípidos plasmáticos en escolares de la ciudad de Cuenca desde 1992 hasta 2004.
Se realizó un estudio transversal en 1.116 niños de 9-10 años de edad de 22 colegios públicos de la provincia de Cuenca en 2004. Además, se analizaron los resultados de 3 estudios transversals llevados a cabo con el mismo método en 1992, 1996 y 1998 en colegios de dicha ciudad.
En el año 2004, en escolares de 9-10 años de edad de la provincia de Cuenca, el 22,0% (intervalo de confianza [IC] del 95%, 19,5-24,4) tenía sobrepeso y el 8,8% (IC del 95%, 7,2-10,5), obesidad. En el período 1992-2004, en escolares de 9-10 años de edad de la ciudad de Cuenca, los niños registraron un aumento absoluto del 12,2% en la prevalencia de sobrepeso más obesidad, que no alcanzó la significación estadística (p > 0,05). En las niñas los cambios en el IMC fueron de menor magnitud y no significativos estadísticamente. Se observaron descensos (p < 0,05) en la presión arterial sistólica (PAS) y la presión arterial diastólica (PAD) en ambos sexos, que fueron mayores en las niñas. En ellas, el descenso de la PAS fue de –9,2 mmHg (IC del 95%, de –7,0 a –11,5) y el de la PAD de -5,9 mmHg (IC del 95%, de –4,2 a –7,5). También se observó la disminución del colesterol no unido a lipoproteínas de alta densidad, que en los niños fue de –18,1 mg/dl (IC del 95%, de –26,0 a –10,1 mg/dl) y en las niñas de -23,7 mg/dl (IC del 95%, de –30,8 a –16,6 mg/dl). El colesterol unido a lipoproteínas de alta densidad aumentó 6,3 mg/dl (IC del 95%, 2,6-10,0 mg/dl) en los niños y 5,1 mg/dl (IC del 95%, 1,9-8,2 mg/dl) en las niñas. Los triglicéridos no se modificaron sustancialmente.
La prevalencia de sobrepeso u obesidad en escolares de la provincia de Cuenca es de las más altas de Europa. En el período 1992-2004, en la ciudad de Cuenca, la frecuencia de sobrepeso u obesidad puede haber aumentado en los varones, mientras que la presión arterial y el perfil lipídico han mejorado en ambos sexos.
The assess the prevalence of overweight and obesity in school children from the province of Cuenca in 2004, and to examine changes in the main cardiovascular risk factors in school children from the city of Cuenca from 1992 through 2004.
Cross sectional survey of 1166 schoolchildren 9-10 years old from 22 public schools of the province of Cuenca. We also analyzed data from 3 earlier, methodologically similar, cross-sectional surveys of school children from the city of Cuenca carried out in 1992, 1996 and 1998.
In 2004, among children aged 9-10 years from the province of Cuenca, 22.0% (95% confidence interval [CI], 19.53-24.37) were overweight and 8.8% (95% CI, 7.16-10.50) were obese. From 1992 through 2004, among children aged 9-10 years from the city of Cuenca, we registered a 12.2% absolute increase in the prevalence of overweight or obesity among males, which did no reach statistical significance (p > 0.05). Among women, changes in body mass index were of lower magnitude and with no statistical significance. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) decreased (p < 0.05) in both sexes, with a greater decline in females. Among the latter, SBP decreased –9.22 mmHg (95% CI, –7.0 to –11.5) and DBP –5.9 mmHg (95% CI, –4.23 to –7.50). Non high density lipoproteins-cholesterol decreased among males (–18.1 mg/dl; 95% CI, –26.0 to –10.1 mg/dl) and among females (–23.7 mg/dl; 95% CI, -30.8 to –16.6 mg/dl). High density lipoproteins-cholesterol increased 6.3 mg/dl (95% CI, 2.6-10.0 mg/dl) in males and 5.1 mg/dl (95% CI, 1.9-8.2 mg/dl) in females. Triglycerides did not show substantial changes over the study period.
Prevalence of overweight or obesity in schoolchildren of Cuenca is among the highest in Europe. From 1992 through 2004 in the city of Cuenca, frequency of overweight or obesity might have increased among males, while blood pressure and the lipid profile improved in both sexes.
Obesity prevalence and tracking of body mass index after a 6 years follow up study in children and adolescents: The cuenca study, Spain
2002, Medicina Clinica
Estimar la prevalencia de sobrepeso y obesidad en escolares de Cuenca, y examinarel mantenimiento del estado ponderal a lo largo de 6 años.
Estudio de seguimiento de factores de riesgo cardiovascular, iniciado en 1992 con unestudio transversal en 307 escolares de 9 a 12 años de edad pertenecientes a tres colegios públicosde Cuenca. En 1998 se examinaron los escolares de 9 a 13 años de edad de los mismoscolegios públicos y los alumnos de 14 a 17 años que ya participaron en el estudio de 1992.Además de variables de carácter sociodemográfico, se determinaron el peso, la talla y el índicede masa corporal (IMC), clasificando a los individuos por estado ponderal como normopeso sobrepesoy obesidad según los criterios del International Obesity Task Force.
La prevalencia de sobrepeso fue del 26,6%, y la de la obesidad del 3,9%. La prevalencia,tanto de sobrepeso como de obesidad, fue mayor en mujeres que en varones, sin quelas diferencias alcanzaran significación estadística. En la cohorte de seguimiento, el coeficientede correlación de Spearman entre el IMC de 1992 y el de 1998 fue 0,72. El coeficiente decorrelación intraclase entre el percentil del IMC en 1992 y en 1998 fue de 0,78. El riesgo relativode los que presentaban sobrepeso u obesidad en 1992 de continuar en este estado ponderalen 1998 fue de 2,9 (intervalo de confianza del 95%, 2,21-4,04).
La prevalencia de sobrepeso y obesidad en los escolares de Cuenca es de las másaltas publicadas hasta ahora en Europa. El grado de mantenimiento del estado ponderal entrela edad prepuberal y la edad pospuberal es alto.
The goals of this study were to estimate the prevalence of overweight and obesityin schoolchildren of Cuenca –a Spanish city–, and to track down both conditions over 6 years.
The follow-up study of cardiovascular risk factors began in 1992 with a cross-sectionalsurvey of 307 children aged 9-12 years old who were recruited in three public schools. On asecond survey in 1998, we examined schoolchildren of the 1992 cohort as well as 9-13 yearsoldschoolchildren from the same public schools. Besides socio-demographics variables, we determinedweight, height and body mass index (BMI). Individuals were classified as having normalweight, overweight and obesity, according to criteria of the International Obesity TaskForce.
Prevalence of overweight was 26.6%, and that of obesity was 3.9%. Overweight andobesity were more frequent in women that in men (not statistically significant differences).Spearman's correlation coefficient in the cohort followed-up between 1992 and 1998 regardingBMI was 0.72. Intra-class correlation coefficient between BMI percentile in 1992 and1998 was 0.78. Relative risk of overweight and obesity in 1998 for individuals who had overweightor obesity in 1992 was 2.9 (95% CI, 2.21-4.04).
Prevalence of overweight and obesity in schoolchildren of Cuenca is among thehighest reported so far. BMI increased from the pre-pubertal through the post-pubertal period.
The magnitude of familial associations of cardiovascular risk factor variables between parents and offspring are influenced by age: The Bogalusa Heart Study
2001, Annals of Epidemiology
PURPOSE: Although parent-offspring associations of cardiovascular risk factor variables are known, the age-specific nature of this familial relationship is not clear.
METHODS: This aspect was examined in 727 unrelated children (mean age: 11.2 years) and their parents who participated in the Bogalusa Heart Study during their childhood (mean age: 11.3 years) and adulthood (mean age: 25.5 years).
RESULTS: After adjusting for covariates, the mothers' childhood-offspring correlations were consistently higher than mothers' adulthood-offspring correlations for body mass index (BMI) [r = 0.45 vs. 0.32], systolic blood pressure (SBP) [r = 0.30 vs. 0.10], diastolic blood pressure (DPB) [r = 0.22 vs. 0.13] and low-density lipoprotein cholesterol (LDLC) [r = 0.20 vs. 0.11]. In contrast, high-density lipoprotein cholesterol (HDLC) and triglycerides did not show such age-specific trends in mother-offspring correlations. Corresponding father-offspring correlations showed similar patterns, but the differences were of lesser magnitude. Multiple regression analyses using offspring's risk factor variables as dependent variables revealed that parents' childhood obesity, blood pressure and LDLC levels were better predictors of the corresponding variables in the young offspring than parents' adulthood values. Further, sex of either parents or offspring made no difference in the above findings.
CONCLUSIONS: The magnitude of the familial associations of cardiovascular risk factor variables between parents and offspring are influenced by age. Intrinsic genetic make-up, duration of exposure to environment and gene-environment interactions may play a role in this association.
Effect of an intervention to improve the cardiovascular health of family members of patients with coronary artery disease: A randomized trial
2014, CMAJ. Canadian Medical Association Journal
Family members of patients with coronary artery disease (CAD) have higher risk of vascular events. We conducted a trial to determine if a family heart-health intervention could reduce their risk of CAD.
We assessed coronary risk factors and randomized 426 family members of patients with CAD to a family heart-health intervention (n = 211) or control (n = 215). The intervention included feedback about risk factors, assistance with goal setting and counselling from health educators for 12 months. Reports were sent to the primary care physicians of patients whose lipid levels and blood pressure exceeded threshold values. All participants received printed materials about smoking cessation, healthy eating, weight management and physical activity; the control group received only these materials. The main outcomes (ratio of total cholesterol to high-density lipoprotein [HDL] cholesterol; physical activity; fruit and vegetable consumption) were assessed at 3 and 12 months. We examined group and time effects using mixed models analyses with the baseline values as covariates. The secondary outcomes were plasma lipid levels (total cholesterol, low-density lipoprotein cholesterol, HDL cholesterol and triglycerides); glucose level; blood pressure; smoking status; waist circumference; body mass index; and the use of blood pressure, lipid-lowering and smoking cessation medications.
We found no effect of the intervention on the ratio of total cholesterol to HDL cholesterol. However, participants in the intervention group reported consuming more fruit and vegetables (1.2 servings per day more after 3 mo and 0.8 servings at 12 mo; p < 0.001). There was a significant group by time interaction for physical activity (p = 0.03). At 3 months, those in the intervention group reported 65.8 more minutes of physical activity per week (95% confidence interval [CI] 47.0–84.7 min). At 12 months, participants in the intervention group reported 23.9 more minutes each week (95% CI 3.9–44.0 min).
A health educator–led heart-health intervention did not improve the ratio of total cholesterol to HDL cholesterol but did increase reported physical activity and fruit and vegetable consumption among family members of patients with CAD. Hospitalization of a spouse, sibling or parent is an opportunity to improve cardiovascular health among other family members. Trial registration: ClinicalTrials.gov, no NCT00552591.
Hypovitaminosis D, Dyslipidaemia and Thyroid Dysfunction among Adolescents and Their Associations with Raised Blood Pressure in a North Eastern City of India
2020, SSRN

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^☆: Financed by a grant from the Health Council of Community Board of Castilla-La Mancha, Spain.

²: To whom correspondence and reprint requests should be addressed at Departamento de Salud Pública, EU de Enfermerı́a, Universidad de Castilla-La Mancha, c/ Camino de Pozuelo s/n, 16002 Cuenca, Spain. Fax: +34 69 179111.

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Regular ArticleFamilial Aggregation of Cardiovascular Disease Risk Factors: The Cuenca Study☆

Abstract

Am J Cardiol

Am J Epidemiol

Prev Med

J Clin Epidemiol

Prev Med

Atherosclerosis

Atherosclerosis

Prevención en la niñez y enla juventud de las enfermedades cardiovasculares del adulto: es el momento de actuar

Use of cholesterol measurements in childhood for the prediction of adult hypercholesterolemia: the Muscatine study

JAMA

Tracking of serum lipids and lipoproteins from childhood to adulthood: the Bogalusa heart study

Am J Epidemiol

Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham heart study

Circulation

J Chron Dis

Cultural and biological determinants of lipoprotein concentrations

Ann Hum Genet

Blood pressure aggregation in families

Am J Epidemiol

Familial aggregation of blood pressure and weight in adoptive families. II. Estimation of the relative contribution of genetic and common environmental factors to blood pressure correlations between family members

Am J Epidemiol

Hereditary and environmental influences on cardiovascular risk factors for children: the Bogalusa heart study

Am J Epidemiol

An adoption study of human obesity

N Engl J Med

Genetics of obesity in adult adoptees and their biological siblings

Br Med J

Familial aggregation of blood pressure in a paediatric population

Acta Paediatr Scand

Adoption study of environmental modifications of the genetic influences on obesity

Int J Obes Relat Metab Disord

The heritability of body mass index among an international sample of monozygotic twins reared apart

Int J Obes Relat Metab Disord

Regular Article
Familial Aggregation of Cardiovascular Disease Risk Factors: The Cuenca Study☆