The West Virginia CARDIAC Project
•
•
•
•
•
•
•
Coronary
Artery
Risk
Detection
In
Appalachian
Communities
“To reduce cardiovascular disease
mortality in West Virginia through
research and intervention in children”
Source: CDC Behavioral Risk Factor Surveillance System.
Health Care Professionals
Health Science Students
School Nurses
RHEP Coordinators
School Principals and Teachers
Within 5 years,
CARDIAC
began
operating in all
WV counties!
CARDIAC Project
Year 1
1998 - 1999
CARDIAC
Project
2003 - present
Why Familial Hypercholesterolemia (Fh) Is Well
Suited To This Approach:
• Single gene disorder with dominant
inheritance
• Causes disproportionate share of
disease
• Easily identifiable
• Amendable to treatments (statins)
Percentage Of Youths < 18 Years
Expected To Have Fh According To Cholesterol
Levels And Closest Relative With Fh
Percentage with FH at that Level
TC
(mg/dl)
LDL
(mg/dl)
200
138
Degree of Relative
First
Second
Third
26.4
10.7
4.9
260
190
99.9
Williams, RR. Am J Cardio 1993; 72: 171-76
99.5
99.0
General
Population
0.07
57.6
Megan Father Mother
TC
222
290
206
HDL
LDL
TG
56
147
97
48
197
226
98
93
73
Universal versus Selective Screening:
Testing Current NCEP Guidelines
20,266 Subjects Tested
(5th Graders)
14,468 met NCEP screening
Guidelines (71.4%)
5,798 did not meet NCEP
Screening guidelines (28.6%)
170 warrant pharmacologic tx
98 warrant pharmacologic tx
(1.2% of those who met
NCEP guidelines)
(1.7% of those who did not
Meet NCEP guidelines)
“Cholesterol Screens Miss Children, Study Says”
By Ron Winslow
• “Data from a school-based program in West Virginia
found that national guidelines regarding cholesterol
screening among children would miss 36% of those
with seriously high LDL.”
FH Family-based Study
(2013)
• Cascade screening of family members*
• 50 FH probands in lipid clinics
• 500 CARDIAC 5th graders LDL > 160mg/dl
• 100 CARDIAC 5th graders LDL > 190mg/dl
*Phenotyping and genotyping
Prevalence Of Obesity
Boys
Girls
26.9
%
21
%
53.1
%
<85th
85-95th
23.4
%
20.7
%
>95th
55.9
%
CARDIAC Screening Results
5th Grade (1998-2011)
• 76,688 students screened since 2011
• 28.3% BMI > 95th percentile
• 18.8% BMI 85-95th percentile
• 23.6% hypertensive
• 25.9% abnormal blood cholesterol
• 5.3% have Acanthosis Nigricans
• 35.5% of AN students were hyperinsulinemic
The West Virginia CARDIAC Project
Coronary
Artery
“To reduce cardiovascular disease,
Risk
diabetes, and other chronic illnesses
in West Virginia through research and
Detection
intervention in children.”
In
Appalachian
Communities
Exploring the Morbidly Obese Diagnosis
RISK FACTOR
NORMAL OR
UNDERWEIGHT
OVERWEIGHT
OBESE
MORBIDLY
OBESE
Elevated Blood Pressure
14.4%
20.8%
29.8%
51.0%
Low HDL
9.7%
18.7%
30.5%
42.7%
Elevated LDL
5.9%
10.2%
13.3%
11.4%
Elevated Triglycerides
4.4%
12.4%
25.0%
31.3%
Positive for AN
.9%
3.5%
13.6%
39.6%
* Ice et al., International Journal of Pediatric Obesity, 2009
FAMILY 116-001
014
015
unk
unk
004
008
007
unk
unk
012
017
011
019
021
unk
nis
020
010
016
unk
unk
nis
unk
009
nis
↑001
003
nis
nis
002
005
nis
nis
nis
006
022
013
018
↑ PROBAND (OO1)
affected male
affected female
nis
lipid profile known but not in sample
unk
lipid profiles unknown & not in sample
Childhood Hypertension
• Nearly always secondary to obesity
• Refer to specialist if BP > 130/85 in normal
weight child
• Rare pathologic causes include:
–
–
–
–
–
–
Coarctation of aorta
Pheochromocytoma
Cushing Syndrome
Chronic kidney disease
Renal artery stenosis
Hyperthyroidism
Childhood Hypertension
• Normal values based on age, gender, height
• 11 year olds
– Boys > 95% 121/78
– Girls > 95% 120/77
• Use large cuff size
• Diastolic pressure is K5 (disappearance of sound)
School-based
Health Promotion
“School health education and promotion
programs for children and young people
constitute the most effective and feasible
prevention approach that can be applied
immediately in most countries.”
World Health Organization Tech. Rep. 792, Pg 73, 1990
CARDIAC Interventions
School-based Programs and Resources
• Web-based Instructional Modules for the School
Curriculum
– Healthy Hearts 4 Kids
– 35,743 students served
– Take Charge! Be Healthy!
– 7835 students served
• Teacher Resources
– Active Academics
• Greenbrier CHOICES Project
Web-based program
that focuses on
improving teen’s
health through
impacting
knowledge,
attitudes, and
behaviors as they
relate to physical
activity, nutrition,
and health.
Student Pre/Post Knowledge
0.8
0.7
0.6
0.5
0.4
Pre Mean
Post Mean
0.3
0.2
0.1
0
Overall Physical Nutrition Related
Act
Health
N=2980
Paired t-test; t=-55.25; p<0.001 for overall and all three topics
Web-based resource
for PreK – 5th grade
teachers that
provides activity
ideas to enhance
the learning of
math, reading,
language arts,
science, social
studies, PE and
health. Also
provides ideas for
energizers, recess
and lunch breaks
AAP 5-2-1-0 Campaign
Obesity Prevention & Treatment:
The Medical Home and Chronic Care Model
Community
Health Systems
Resources and Policies
Organization and Health Care
Informed,
Activated
Patient
Productive
Interactions
Improved Outcomes
Prepared,
Proactive
Practice Team
Population-based Intervention
ActiveWV 2015: The WV Physical Activity Plan
The AIM of the WVPAP
• To create a statewide culture that facilitates physically active
lifestyles in every societal sector and in every region of the state,
regardless of socio-demographic factors, or other barriers we may
face
Intended Outcomes
• Buy-in and support from sector-specific leaders at both the state and
local levels (short term)
• Policy, environmental, and programming changes at the state and
local levels (intermediate term)
• Increase/maintain the physical activity levels of both children and
adults to meet or exceed the national physical activity
recommendations (long term)
London Transport Workers
(1950)
Conductors outlive drivers
Collaboration between
Central WV Medical Society
and Stonewall Resort
Greenbrier CHOICES Project
Children’s Health Opportunities Involving Coordinated Efforts in Schools
• Funded by a Carol M White Physical Education
Program (PEP)Grant, US Dept of Education,
(Awarded 9/29/2011, in Year 2)
• 76 recipients nationwide
• $890,000.00 over three years
• Focus on making Greenbrier County (WV) youth
healthier and more physically active!
– Two middle schools – approx. 1200 students
McDowell CHOICES Project
Children’s Health Opportunities Involving Coordinated Efforts in Schools
• 6-month Planning Grant funded by the Highmark
Foundation (Awarded 10/19/2012)
• In Preparation for a two-year Intervention Grant, June
2013
• Focus on making McDowell County (WV) youth
healthier and more physically active!
– All 10 schools in McDowell County (PK-12) (programming,
equipment, faculty development, after-school opportunities)
– New Community Play Space
– Community Programming and Joint Use Agreements for
more availability of environments that promote PA
Health Status of WV School Children
is Improving*
• 5th graders
– Hypertension decreased from 23.9% to 20.3%
– Obesity declined from 28.9% to 27.8%
– Abn. cholesterol declined from 26.1% to 23.5%
• Kindergarten
– Obesity declined from 17.5% to 13.6%
*2011-12 vs 2010-11
Mean of non-HDL
Mean non-HDL by year of
screening
122
120
118
116
114
112
110
108
106
104
102
100
5
6
7
8
9
10
Year of screening
11
12
13
14
HANCOCK
RESA Regions
BROOKE
OHIO
MARSHALL
VI
MONONGALIA
WETZEL
TYLER
PLEASANTS
WOOD
HARRISON
TAYLOR
DODDRIDGE
RITCHIE
LEWIS
GILMER
CALHOUN
UPSHUR
ROANE
V
MASON
PUTNAM
WAYNE
WEBSTER
NICHOLAS
III
II
POCAHONTAS
FAYETTE
BOONE
RALEIGH
WYOMING
MCDOWELL
I
GREENBRIER
IV
LOGAN
MINGO
SUMMERS MONROE
MERCER
BERKELEY
MINERAL
HAMPSHIRE
GRANT
TUCKER
HARDY
VIII
PENDLETON
KANAWHA
LINCOLN
MORGAN
RANDOLPH
BRAXTON
CLAY
CABELL
VII
BARBOUR
WIRT
JACKSON
PRESTON
MARION
JEFFERSON
Coordinated School Wellness
Programs
HANCOCK
CARDIAC
2012-2013
BROOKE
Kathryn Greenlief - 304-276-4052
Program Manager - Northern
kgreenlief@hsc.wvu.edu
OHIO
Dalena Riggs - 304-692-6741
driggs2@hsc.wvu.edu
MARSHALL
Robin VanFleet - 304-692-6743
rvanfleet@hsc.wvu.edu
MONONGALIA
WETZEL
PLEASANTS
PRESTON
HARRISON
MINERAL
TAYLOR
LEWIS
WIRT
GILMER
CALHOUN
JACKSON
UPSHUR
ROANE
MASON
HAMPSHIRE
JEFFERSON
GRANT
RITCHIE
BARBOUR
Tina Whitt - 304-593-4319
twhitt@hsc.wvu.edu
BERKELEY
16+
DODDRIDGE
WOOD
MORGAN
MARION
TYLER
TUCKER
HARDY
RANDOLPH
BRAXTON
PENDLETON
PUTNAM
CABELL
Valerie Minor - 304-457-6350
vminor@hsc.wvu.edu
WEBSTER
CLAY
KANAWHA
NICHOLAS
WAYNE
POCAHONTAS
LINCOLN
FAYETTE
BOONE
GREENBRIER
LOGAN
RALEIGH
MINGO
WYOMING
Janetta Massie - 304-890-9490
jmassie@hsc.wvu.edu
Tammy Pyle-Vicars - 304-812-4469
Program Manager - Southern
tpyle@hsc.wvu.edu
MCDOWELL
SUMMERS
MERCER
MONROE
Nahied Haidar - 304-293-4286
Greenbrier CHOICES Project
nhaidar@hsc.wvu.edu
declined
RESA and CARDIAC
Potential for collaboration
1. Health promotion (education)
2. Interventions
3. Facilitate Medical Home model
CARDIAC Team
CARDIAC and CPASS*
• ActiveWV 2015 (WV PAP)
• Rx for Health: A Healthcare and State Parks
Collaborative
• Greenbrier County CHOICES (USDE)
• McDowell County CHOICES (Highmark Foundation)
* WVU College of Physical Activity and Sports Science
CPASS Colleagues
Emily Jones Ph.D.
Eloise Elliott PhD
Sean Bulger ED.D
School of Public Health Colleagues
Alfgeir L. Kristjansson Ph.D.
Christa Lilly Ph.D.