Department of Pediatrics and WVU Children's Hospital, West Virginia University School of Medicine, Morgantown, WV, USA.
Department of Biostatistics, WVU School of Public Health, Morgantown, WV, USA.
J Clin Lipidol. 2020 Nov-Dec;14(6):762-771. doi: 10.1016/j.jacl.2020.09.003. Epub 2020 Sep 17.
The Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project is a state-wide risk factor screening program that operated in West Virginia for 19 years and screened more than 100,000 5th graders for obesity, hypertension, and dyslipidemia.
We investigated siblings in the CARDIAC Project to assess whether cardiometabolic risk factors (CMRFs) correlate in siblings.
We identified 12,053 children from 5752 families with lipid panel, blood pressure, and anthropometric data. A linkage application (LinkPlus from the U.S. Centers for Disease Control and Prevention) matched siblings based on parent names, addresses, telephone numbers, and school to generate a linkage probability curve. Graphical and statistical analyses demonstrate the relationships between CMRFs in siblings.
Siblings showed moderate intraclass correlation coefficient of 0.375 for low-density lipoprotein cholesterol (LDL-C), 0.34 for high-density lipoprotein cholesterol (HDL-C), and 0.22 for triglyceride levels. The body mass index (BMI) intraclass correlation coefficient (0.383) is slightly better (2%) than LDL-C or HDL-C, but the standardized beta values from linear regression suggest a 3-fold impact of sibling LDL-C over the child's own BMI. The odds ratio of a second sibling having LDL-C < 110 mg/dL with a first sibling at that level is 3.444:1 (Confidence Limit 3.031-3.915, P < .05). The odds ratio of a sibling showing an LDL-C ≥ 160 mg/dL, given a first sibling with that degree of elevated LDL-C is 29.6:1 (95% Confidence Limit: 15.54-56.36). The individual LDL-C level correlated more strongly with sibling LDL-C than with the individual's own BMI. Seventy-eight children with LDL-C > 160 mg/dL and negative family history would have been missed, which represents more than half of those with LDL-C > 160 mg/dL (78 vs 67 or 54%).
Sibling HDL-C levels, LDL-C levels, and BMIs correlate within a family. Triglyceride and blood pressure levels are less well correlated. The identified CMRF relationships strengthen the main findings of the overall CARDIAC Project: an elevated BMI is not predictive of elevated LDL-C and family history of coronary artery disease poorly predicts cholesterol abnormality at screening. Family history does not adequately identify children who should be screened for cholesterol abnormality. Elevated LDL-C (>160 mg/dL) in a child strongly suggests that additional siblings and parents be screened if universal screening is not practiced.
冠状动脉风险检测在阿巴拉契亚社区（CARDIAC）项目是一个全州范围的危险因素筛查计划，在西弗吉尼亚州运行了 19 年，为超过 100,000 名五年级学生筛查了肥胖、高血压和血脂异常。
我们调查了 CARDIAC 项目中的兄弟姐妹，以评估心脏代谢危险因素（CMRFs）在兄弟姐妹之间是否相关。
我们从 5752 个家庭中确定了 12053 名儿童，他们的血脂谱、血压和人体测量数据。一个链接应用程序（美国疾病控制和预防中心的 LinkPlus）根据父母的姓名、地址、电话号码和学校对兄弟姐妹进行匹配，生成链接概率曲线。图形和统计分析表明了兄弟姐妹之间 CMRF 之间的关系。
兄弟姐妹的低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）和甘油三酯水平的个体内相关系数分别为 0.375、0.34 和 0.22。身体质量指数（BMI）的个体内相关系数（0.383）略好（2%）于 LDL-C 或 HDL-C，但线性回归的标准化β值表明，兄弟姐妹的 LDL-C 对孩子自身 BMI 的影响是其 3 倍。第二个兄弟姐妹的 LDL-C<110mg/dL，而第一个兄弟姐妹的 LDL-C 处于该水平，其 LDL-C<110mg/dL 的比值为 3.444:1（置信区间为 3.031-3.915，P<.05）。给定第一个兄弟姐妹 LDL-C 升高的程度，第二个兄弟姐妹 LDL-C≥160mg/dL 的比值为 29.6:1（95%置信区间：15.54-56.36）。个体 LDL-C 水平与兄弟姐妹的 LDL-C 比与个体自身的 BMI 更密切相关。78 名 LDL-C>160mg/dL 且无家族史的儿童将被漏诊，这代表了 LDL-C>160mg/dL 儿童的一半以上（78 比 67 或 54%）。
家庭内兄弟姐妹的高密度脂蛋白胆固醇（HDL-C）水平、低密度脂蛋白胆固醇（LDL-C）水平和 BMI 呈正相关。甘油三酯和血压水平相关性较差。确定的 CMRF 关系加强了总体 CARDIAC 项目的主要发现：BMI 升高不能预测 LDL-C 升高，冠心病家族史不能很好地预测筛查时的胆固醇异常。家族史不能充分识别需要进行胆固醇异常筛查的儿童。如果不进行普遍筛查，儿童 LDL-C 升高（>160mg/dL）强烈提示应进一步筛查兄弟姐妹和父母。
