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The Bogalusa Heart Study

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1972 – 2016


History of the Bogalusa Heart Study

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The Bogalusa Heart Study is the longest and most detailed study of a biracial (black-white) population of children in the world. The focus is on understanding the early natural history of coronary artery disease and essential hypertension. It is the only major program studying a total and geographically well-defined, biracial, and semi-rural community. The main community of Bogalusa, Louisiana is comparable to many other communities in southeastern United States.

Since 1972, when selected as a National Institutes of Health sponsored Specialized Centers of Research – Arteriosclerosis (SCOR-A) at Louisiana State University Medical Center, the Bogalusa Heart Study has been responsible for conducting C-V risk factor research both in the community and in the laboratory, and is now the flagship study for the Tulane Center for Cardiovascular Health. Funding for the research has come from National Heart, Lung and Blood Institute, the National Institute for Child Health and Human Development, the National Institute of Aging, and the American Heart Association. A highly skilled and trained, multi-disciplinary team of anthropologists, biochemists, cardiologists, epidemiologists, geneticists, nurses, nutritionists, psychologists, sociologists, and statisticians have worked together to study hereditary and environmental aspects of early coronary artery disease (CAD).

Over 160 Substudies have been conducted over the years. These sub-studies include special studies on socioeconomic evaluations, blood pressure studies, a lipids study, genetics studies, exercise, heart murmur studies, newborn cohort, diabetes, pathology, and C V imaging, to mention just a few. Currently there are follow up studies of the children cohorts, which carries individuals up to the age of 50 years, as well as studies of subjects with/without parental history of coronary heart disease, hypertension and diabetes. Blood samples have been sent to Boston, Johns Hopkins, Houston, Sweden and Finland for special analyses.

More than 1,000 publications, five textbooks and numerous monographs have been produced which describe cross-sectional and longitudinal observations on more than16,000 children and adults in Bogalusa, Louisiana. Results from the Bogalusa Heart Study give a clear picture of the early natural history of C-V risk factors, early coronary artery disease, type II, adult onset diabetes mellitus, and essential hypertension in a black-white population. Numerous other publications have concerned the obesity epidemic.

The most impressive accomplishments of the Bogalusa Heart Study can be summarized as follows:

• Observations clearly show that the major etiologies of adult heart disease, atherosclerosis, coronary heart disease, and essential hypertension begin in childhood. Documented anatomic changes occur by 5 to 8 years of age.

• C V risk factors can be identified in early life. Methods to study C V risk factors are now developed, and normative values from a large biracial (black-white) population (approximately 10,000 individuals) are available for comparison.

• The levels of risk factors in childhood are different than those in the adult years. Levels change with growth phases, i.e. in the first year of life, during puberty and adolescence, in the transition to young adulthood and in adulthood. National Institute on Aging is now funding observations related to aging and longevity.

• Autopsy studies show atherosclerotic lesions in the aorta and coronary vessels, and changes in the kidney vasculature relate strongly to clinical C V risk factors, clearly indicating atherosclerosis and hypertension begin in early life. Imaging studies of the heart, carotid and femoral arteries are extending these findings.

• Gender and race contrasts are a major contribution to the research findings. It is well known blacks have more and a severer form of hypertension, more diabetes, white males early coronary artery disease, and women show a lag in the development of heart disease. Subtle changes of aging are reflecting a life long burden of C V risk factors.

• Environmental factors are significant and influence dyslipidemia, hypertension, and obesity. Those that are controllable include diet, exercise, and cigarette smoking.

• Characteristics that relate to early onset of Type II diabetes are a main interest.

• Lifestyles and behaviors that influence C V risk are learned and begin early in life. Healthy lifestyles should be adopted in childhood, because they are critical to modulation of risk factors later in life. Primary care physicians, pediatricians and cardiologists 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.

• In the education of young children, consideration of social problems like dropout rates, violent behavior, and teenage pregnancy have become equally important to prevention and control of risk factors through primordial prevention. Health prevention is advocated to become part of public education beginning in kindergarten.

Knowledge gained in the Bogalusa Heart Study has been applied to develop, test and evaluate methods for C-V risk intervention. Investigators of the Tulane Center for Cardiovascular Health, the Tulane University School of Public Health and Tropical Medicine, the Louisiana State Department of Health and the Jefferson and Orleans Parish School Systems collaborated to develop an intervention program for elementary school children called “Health Ahead/Heart Smart”. This represents a comprehensive health education and promotion program that is a result of the first NIH appointed National Research and Demonstration Center – Arteriosclerosis at Louisiana State University medical Center.

A two-day symposium was held in April 1994 to celebrate the 20th anniversary of the Bogalusa Heart Study. The first day of the symposium featured lectures on the natural history of heart disease and included speakers with expertise on the "deadly quartet" -- obesity, high blood pressure, high cholesterol, and diabetes, or metabolic syndrome and insulin resistance. The Bogalusa Heart Study was showcased with discussions on its research contributions and their significance in understanding early heart disease in children. Obesity and its impact on C V risk and autopsy evidence of atherosclerosis in young individuals were highlighted. Day two honed in on "The Art of Prevention-- Healthy People 2000." Invited lecturers included top people in the field of cardiology. Claude Lenfant, M.D., Director of the National Heart, Lung, and Blood Institute, National Institutes of Health, provided the keynote address. Outstanding speakers covered the Framingham Heart Study, Evan's County on Ethnicity of Heart Disease, and new approaches to heart disease through prevention and education. Proceedings were published in The American Journal of the Medical Sciences (Am J Med Sci. 1995 Dec;310 Suppl 1:S3-7. Review).

Throughout the years the parents, children and schools of Bogalusa have enthusiastically and steadfastly supported the program. Forty years after the first feasibility and developmental studies in Franklinton, Louisiana, the Bogalusa Heart Study is still ongoing. With the support of the entire Bogalusa Community, The Bogalusa Heart Study continues to provide significant and useful data for what in the future may be the elimination of America's number one killer- heart disease.

 

Tulane University, New Orleans, LA 70118 504-865-5000 website@tulane.edu