Since its inception CARDIAC has grown from a small school-based CVD surveillance project piloted in three rural WV counties to an expanded multidimensional effort involving all of the state's 55 counties. CARDIAC has two components, a school-based surveillance and intervention initiative, and a targeted individualized approach towards identifing and refering for treatment those individuals with the most severe genetic cause of death from premature CVD, familial hypercholesterolemia (FH).

School-based screenings

All 5th grade public school children in WV are eligible to participate in the CARDIAC Project. The study protocol is approved by the West Virginia University Institutional Review Board for the Protection of Human Subjects, and written permission for schools to participate is granted by each of the 55 county school superintendents.

Of 36,477 eligible children between 1998-2003, consent to participate was obtained from 16,410 (45%). Ethnicity was determined by self report and was reflective of the high percentage of whites in the general population of West Virginia (96.9%).

Screening measures for Kinder and Too

Parents complete items related to family and child demographics and family history of cardiovascular risk factors such as heart disease, hypertension, and diabetes on the screening/consent form.  The second page of the screening/consent form is used by CARDIAC Project members to record children’s height, weight, body mass index (BMI), and BMI percentile.  Children’s height (cm) and weight (kg) are measured using the SECA Road Rod stadiometer (78”/200 cm) and the SECA 840 Personal Digital Scale.  Body mass index for each child is calculated using the recommended equation by the Centers for Disease Control17: weight (kg)/ height (cm) 2 * 10,000.  All weight percentile categories (e.g., normal, at risk for overweight, overweight) were based on the age and gender-specific growth charts recommended by the CDC (Hammer, Kraemer, Wilson, Ritter, & Dornbusch, 1991; Pietrobelli, Faith, Allison, Gallagher, Chiumello, & Heymsfield, 1998).  At risk for overweight is based on BMI 85th to 94.9th percentiles; the overweight categorization is based on > 95th percentile.  Kindergarten and second grade students are also screened for a marker of elevated risk for diabetes, Acanthosis Nigricans (AN).  When present, and is a darkened pigment of skin at the base of a child’s neck, particularly in the back of the neck.  Trained health professionals and students screen children within the school setting.  All screening information is mailed to the children’s families using a comprehensive health report.  Each report contains additional information on how to interpret the screening results and what additional services may be needed.  Recommendations for how to maintain a healthy lifestyle such as eating healthy foods and obtaining the recommended amount of physical activity are also provided.

Screening measures for Kid and Teen

Parents complete items related to family and child demographics and family history of cardiovascular risk factors such as heart disease, hypertension, and diabetes on the screening/consent form.  The second page of the screening/consent form is used by CARDIAC Project members to record children’s height, weight, body mass index (BMI), and BMI percentile.  Children’s height (cm) and weight (kg) are measured using the SECA Road Rod stadiometer (78”/200 cm) and the SECA 840 Personal Digital Scale.  Body mass index for each child is calculated using the recommended equation by the Centers for Disease Control17: weight (kg)/ height (cm) 2 * 10,000.  All weight percentile categories (e.g., normal, at risk for overweight, overweight) were based on the age and gender-specific growth charts recommended by the CDC (Hammer, Kraemer, Wilson, Ritter, & Dornbusch, 1991; Pietrobelli, Faith, Allison, Gallagher, Chiumello, & Heymsfield, 1998).  At risk for overweight is based on BMI 85th to 94.9th percentiles; the overweight categorization is based on > 95th percentile.  Kindergarten and second grade students are also screened for a marker of elevated risk for diabetes, Acanthosis Nigricans (AN).  When present, and is a darkened pigment of skin at the base of a child’s neck, particularly in the back of the neck.  Trained health professionals and students screen children within the school setting.  All screening information is mailed to the children’s families using a comprehensive health report.  Each report contains additional information on how to interpret the screening results and what additional services may be needed.  Recommendations for how to maintain a healthy lifestyle such as eating healthy foods and obtaining the recommended amount of physical activity are also provided.

The U.S. Center for Disease Control and Prevention has increasingly focused on the role of genomics as a pivotal part of determining health status. Family history of disease is the link between environmental exposure and genetic susceptibility. In October 2000 CDC funded the high risk individualized component of CARDIAC, Addressing Familial Hypercholesterolemia: A Model Program For States.

Familial hypercholesterolemia (FH) fulfills the World Health Organization criteria for screening and intervention because it covers a disproportionate burden of chronic disease, is easily identifiable by blood cholesterol measurement, and can be effectively treated by cholesterol lowering medication and diet. FH represents the most severe 4% of all types of dyslipidemia, causing premature death in men and women by 15-20 years. It occurs in approximately 1 in 500 in the worldwide population; but its frequency is higher in selected sub-population where 'founders mutations' have been discovered. Given that two-thirds of the original settlers of West Virginia were Scotch-Irish, among whom a specific mutation for FH has been discovered, it is intriguing to speculate that some of our excess mortality from heart disease is a result of genetic influences in addition to lifestyle habits.

As an autosomal co-dominant single gene defect FH affects half of all close relatives of individuals with the disease (probands). Once index cases are identified by multiple referral sources, including the school-based screening component of CARDIAC, pedigree analysis is performed and family members are provided the opportunity for full fasting lipid profile measurement. Selected family studies are underway to characterize LDL-receptor activity and gene analysis.

The Coronary Artery Risk Detection In Appalachian Communities (CARDIAC) Project was initiated in 1998 as a means of reversing this disparity in CVD. Comprehensive in design, CARDIAC has two components, a school-based surveillance and intervention initiative, and a targeted individualized approach toward identification and referral for treatment those individuals with the most severe genetic cause of death from premature CVD: familial hypercholesterolemia (FH). CARDIAC is the first statewide CVD intervention program of its kind in the nation. Since its inception CARDIAC has grown from a small school-based CVD surveillance project piloted in three rural WV counties to an expanded multidimensional effort involving all of the state's 55 counties.

The CARDIAC Project relies on the continued support from the West Virginia Executive and Legislative Branches, The Centers for Disease Control (CDC), The Claude Worthington Benedum Foundation, and The Robert Wood Johnson Foundation.

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