Welcome to the Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project Research Program. Our goal is to apply high-level analysis of acquired data so as to accurately inform health promotion and disease prevention strategies for West Virginia families and communities.


  1. Produce scientific presentations and posters, manuscripts, reports, book and book chapters produced by members of the CARDIAC Team on an annual basis.
  2. Support funding efforts utilizing CARDIAC data and solicit supportive funding for CARDIAC related activities.
  3. Utilize CARDIAC data to educate health science and public health students on appropriate techniques of bio statistical and epidemiological research.
  4. Summarize the most important information acquired as a result of CARDIAC surveillance and interventional activities.

Recent Research and Policy Activities

  • CARDIAC data strongly supported changes in national guidelines recommending universal screening of youth. (Ritchie et al, 2010)
  • CARDIAC’s work with FH supports CDC’s elevated focus on identification and treatment of FH identified now as a Tier One Priority.
  • CARDIAC conducts and reports the required 2nd and 5th grades Body Mass Index (BMI) scores as required by this law by WV House Bill 2816 –The Healthy Lifestyles Act of 2006.
  • The CARDIAC team provides the web-based resource Active Academics free to all WV K-8 classroom teachers to help them integrate physical activity in the classroom setting throughout the day, as well as provides workshops for WV teachers and administrators. These are recommended to schools by the WVDE for WVBE Policy 2510 implementation (7/2014) Modeled after the National Physical Activity Plan, WV was one of only two states to develop a statewide plan to serve as a blueprint for state leaders and policy makers to promote physical activity in all population sectors. ActiveWV 2015: WV Physical Activity Plan.
  • CARDIAC team members serve as leaders in health promotion/research and support state initiatives by providing science-informed data, research, and expertise. Some examples include: WV Health Innovation Collaborative, WV Physical Activity Plan, WVBPH CHOICES Initiative, National FH Foundation Chairman of the Board, US President’s Council on Fitness, Sports, and Nutrition Science Board., Let’s Move Active Schools National Initiative, etc.

Highlights and Materials from Current and Past Projects

CARDIAC’s founding director, Dr. William Neal, has sustained a particular interest in utilizing CARDIAC data to diagnose children with hyperlipidemia (high cholesterol) and a genetic condition called familial hypercholesterolemia (FH). He has published extensively in the area. Results have contributed to a national foundation (CASCADE-FH)’s research into and understanding of FH. Examples of these publications include:

  • John, C. & Neal, W. Screening children for hyperlipidemia by primary care physicians in West Virgina.WV Med J 108, 30-35 (2012). PMID: 22792653
  • Knowels, J.W., et al. Reducing the burden of disease and death from familial hypercholeterolemia: A call to action. Am Heart J168, 807-811 (2014). PMID: 25458642
  • Neal, W.A., Knowles, J. & Wilemon, K. Underutilization of cascade screening for familial hypercholesterolemia. Clinical Lipidology 9, 291-293 (2014).
  • deGoma, E.M., et al.Treatment gaps in adults with heterozygous Familial Hypercholesterolemia in the United States: Data from the CASCADE-FH Registry. Circ Cardiovasc Genet 9, 240-249 (2016). PMID: 27013694

Bioinformatics and pediatric cardiology

CARDIAC's current co-director, Dr. Lee Pyles, brings to CARDIAC an interest in the use of bioinformatics. A few recent publications from his research include:

  • Geradin, J.F., Menk, J.S., Pyles, L.A., Marting, C.M. & Lohr, J.L. Compliance with Adult Congenital Heart Disease Guidelines: Are We Following Recommendations? Congenit Heart Dis 11, 245-253 (2016). PMID: 26554543
  • Pyles, L.A. Testing the Consensus-Based Emergency Information Form. Pediatrics 138(2016). PMID: 274365505

CARDIAC Kinder Program

The CARDIAC Kinder Program was chosen as a National Cancer Institute's Research-Tested Intervention Programs (RTIPs) of the Cancer Control P.L.A.N.E.T. For more information, please review the materials listed below:

  • Cottrell, L., et al. A kindergarten cardiovascular risk surveillance study: CARDIAC-Kinder. American Journal of Health Behavior29, 595-606 (2005). PMID: 16336114

Pregnancy and birth factors associated witho obesity and other cardiovascular risks later in childhood

There is evidence that factors during pregnancy and fetal life influence long-term outcomes in adults such as coronary artery disease, hypertension, and stroke. We are exploring some of those outcomes in the intermediate age groups that we have available in the CARDIAC database. Publications include:

  • Umer A., et al. Assoication between Breastfeeding and Childhood Obesity: Analysis of a Linked Longitudinal Study of Rural Appalachian Fifth-Grade Children. Child Obes 11, 449-455 (2015). PMID: 26186180
  • Mullett, M.D., et al. Association between birth characteristics and coronary disease risk factors among fifth graders. J Pediat 164, 78-82 (2014). PMID: 24120018

Childhood obesity and vulnerability to other health issues

Childhood obesity is associated with a variety of health issues. CARDIAC research has demonstrated an association between childhood obesity (particularly morbid obesity) and increased risk for metabolic syndrome, dyslipidemia, insulin resistance, and asthma. Publications include:

  • Cottrell, L., Neal, W.A., Ice, C., Perez, M.K. & Piedimonte, G. Metabolic abnormalities in children with asthma. Am J Respir Crit Care Med 183, 441-448 (2011). PMID: 20851922
  • Ice, C.L., Cotrell, L. & Neal, W.A. Body mass index as a surrogate measure of cardiovascular risk factor clustering in fifth-grade children: resuts from the coronary artery risk detection in Appalachian Communities Project. Int J Pediat Obes 4, 316-324 (2009). PMID: 19922047
  • Ice CL, Murphy E, Cottrell L, Neal, WA. Morbidly obese diagnosis as an indicator of cardiovascular disease risk in children: results from the CARDIAC Project. Int J Pediat Obes. 2011; 6(2):113-9. PMID: 20545480.
  • Ice, C.L., Cottrell, L., Murphy, E., Minor, V.E., & Neal, W. (2009). Metabolic syndrome in 5th grade children with acanthosis nigricans: Results from the Cornonary Artery Risk Detection in Appalachian Communities Project. World Journal of Pediatrics. 5, 23-30.


The mission of the Prevention Research Centers’ Cardiovascular Health Intervention Research and Translation Network (CHIRTN) was to contribute to cardiovascular health for all people through the development and implementation of a coordinated applied research and translation agenda, and through the conduct of prevention research and translation activities that promote cardiovascular health. Publications from CHIRTN projects are listed below.

  • Lilly CL, Bryant LL, Msha, Leary JM, Vu MB, Hill-Briggs F, et al. Evaluation of the effectiveness of a problem-solving intervention addressing barriers to cardiovascular disease prevention behaviors in 3 underserved populations: Colorado, North Carolina, West Virginia, 2009. Preventing chronic disease. 2014;11:E32. PMID: 24602586
  • Bryant LL, Chin NP, Cottrell LA, Duckles JM, Fernandez ID, Garces DM, et al. Perceptions of cardiovascular health in underserved communities. Preventing chronic disease. 2010;7(2):A30. PubMed PMID: 20158958
  • Farris RP, Pearson T, Fogg T, Bryant L, Peters K, Keyserling T, et al. Building capacity for heart disease and stroke prevention research: the cardiovascular health intervention research and translation network. Health Promot Pract. 2008;9(3):220-7. PMID: 18560014.
  • Sheridan SL, Viera AJ, Krantz MJ, Ice CL, Steinman LE, Peters KE, et al. The effect of giving global coronary risk information to adults: a systematic review. Arch Intern Med. 2010;170(3):230-9. PMID: 20142567.
  • Ton, T.G.N., et al. Knowledge, perception, and behaviors of relatives of people with premature heart disease. Circulation 124, 958-964 (2011). PMID: 21859983

Childhood obesity, physical fitness, and academic performance

During the 2005-2006 school year, researchers affiliated with the Wood County Schools L.I.F.E. project examined relationships between BMI, FITNESSGRAM, academic achievement, and children’s meal enrollment (free/reduced lunch). They learned:

  1. Children’s meal program enrollment significantly affected their academic performance on all 4 academic achievement tests. Students with free/reduced lunch (proxy for SES) score lower on academic achievement tests.
  2. Children in the healthy zone for aerobic fitness (miler run, pacer) score higher on all 4 academic achievement tests – mathematics, reading/language arts, science, social studies, even when controlled for SES.

During the 2007-2008 school year, the database was expanded to include grades 6, 7, and 8. As a result, associations between academic performance and fitness were determined across grades K-8 at one time as well as longitudinally (e.g. 7th grade students now as well as those 7th grade students longitudinally with their data from previous years.) Results:

  1. Confirm the association between aerobic fitness and academic performance.
  2. Suggest that students in the healthy zone for aerobic fitness in both 5th and again in 7th grade scored best in academic achievement tests. Students not in the healthy fitness zone at both points scored the lowest of all 4 groups (See below)

Publications associated with Wood County schools include:

  • Wittberg R, Northrup K, Cottrell L. Children's Physical Fitness and Academic Performance. American Journal of Health Education. 2009;40(1):30-6.
  • Northrup KL, Cottrell LA, Wittberg RA. L.I.F.E.: a school-based heart-health screening and intervention program. J Sch Nurs. 2008;24(1):28-35. PubMed PMID: 18220453.
  • Cottrell LA, Northrup K, Wittberg R. The extended relationship between child cardiovascular risks and academic performance measures. Obesity (Silver Spring). 2007;15(12):3170-7. PubMed PMID: 18198328.

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