CORONARY RISK-FACTORS IN ADOLESCENTS RELATED TO THEIR KNOWLEDGE OF FAMILIAL CORONARY HEART-DISEASE AND HYPERCHOLESTEROLEMIA - THE MUSCATINESTUDY

Objective. To determine the utility of a school-based questionnaire, t o identify adolescents with adverse coronary risk factor levels. Desig n. In Muscatine, IA, students (9th through 12th grade) completed a que stionnaire providing medical history information about first- and seco nd-degree relatives. Anthropometric measures were obtained and blood p ressure, lipid, lipoprotein, and apolipoprotein levels were determined . Results. A history of parental coronary heart disease (CHD) was rare and a history of parental high cholesterol frequently was unknown; ho wever, when known, a history of high cholesterol or early (30 to 55 ye ars of age) or later (>55 years of age) CHD (myocardial infarction, co ronary bypass, or death from a heart attack) in grandfathers enriched the identification of adolescents with adverse coronary risk factors. Parental history of CHD was associated with an increased risk for high body mass index and low apolipoprotein Al levels in their children. G randfather history of early or later CHD was associated with an increa sed risk for low apolipoprotein Al and high density lipoprotein choles terol levels and high body mass index in their grandchildren. Students with positive grandfather histories of high cholesterol had higher to tal cholesterol, low density lipoprotein cholesterol, apolipoprotein B , and low density lipoprotein cholesterol to high density lipoprotein cholesterol ratios. Grandmother histories, because most were negative, did not help identify adolescents in this population with adverse cor onary risk factors. Conclusions. A parental history of CHD as well as a grandfather history of high cholesterol or CHD enriches the identifi cation of children with adverse coronary risk factor levels. The posit ive predictive values associated with using a school-based history obt ained from adolescents, many with the aid of their parents, are small and many adolescents do not know their family history. It is essential that pediatricians inquire about parental and especially grandparenta l medical histories in accordance with the National Cholesterol Educat ion Program guidelines to help identify children at highest familial r isk. The importance of determining parental and grandparental historie s of CHD or hypercholesterolemia should be emphasized to families who are uncertain of their histories to identify children and adolescents who require a physician's care. It is also important for pediatricians to remind their colleagues who care for patients with premature ische mic heart disease to refer their progeny for pediatric care so that th eir lipids and lipoproteins may be screened and counseling provided.