Source: CDC Behavioral Risk Factor Surveillance System.

The West Virginia CARDIAC Project

• Coronary• Artery• Risk• Detection• In• Appalachian• Communities

“To reduce cardiovascular disease mortality in West Virginia throughresearch and intervention in children”

Health Care Professionals

Health Science Students

School Nurses

RHEP Coordinators

School Principals and Teachers

CARDIAC Project

Year 1

1998 - 1999

Within 5 years, CARDIAC

began operating in all WV counties!

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)

Degree of Relative First Second Third

General Population

200 138 26.4 10.7 4.9 0.07

260 190 99.9 99.5 99.0 57.6

Williams, RR. Am J Cardio 1993; 72: 171-76

Megan Father Mother

TC 222 290 206

HDL 56 48 98

LDL 147 197 93

TG 97 226 73

20,266 Subjects Tested(5th Graders)

14,468 met NCEP screening Guidelines (71.4%)

5,798 did not meet NCEPScreening guidelines (28.6%)

170 warrant pharmacologic tx (1.2% of those who met

NCEP guidelines)(1.7% of those who did not

Meet NCEP guidelines)

Universal versus Selective Screening:Testing Current NCEP Guidelines

98 warrant pharmacologic tx98 warrant pharmacologic tx

“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

53.1%

26.9%

21%

<85th 85-95th >95th

23.4%

20.7%

55.9%

Boys Girls

CARDIAC Screening Results5th 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

Risk

Detection

In

Appalachian

Communities

“To reduce cardiovascular disease, diabetes, and other

chronic illnesses in West Virginia through

research and intervention in children.”

Exploring the Morbidly Obese Diagnosis

RISK FACTOR NORMAL ORUNDERWEIGHT

OVERWEIGHT OBESE MORBIDLYOBESE

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

008

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018

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010

002

009

unk

nis

020

017

nis

unk

unk

005 006 022

019 unk016

013

affected male

nis lipid profile known but not in sample

affected female

unk lipid profiles unknown & not in sample

↑ PROBAND (OO1)

FAMILY 116-001

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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-basedHealth 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 InterventionsSchool-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

Overall Physical Act

Nutrition Related Health

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

Pre MeanPost Mean

Paired t-test; t=-55.25; p<0.001 for overall and all three topics

N=2980

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

Health SystemsOrganization and Health Care

CommunityResources and Policies

Productive Interactions

Prepared,Proactive

Practice Team

Informed, Activated

Patient

Improved Outcomes

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 ProjectChildren’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 ProjectChildren’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

5 6 7 8 9 10 11 12 13 14100

105

110

115

120

125

Mean non-HDL by year of screening

Year of screening

Mea

n o

f n

on

-HD

L

PRESTONMONONGALIA

MARION

TAYLORHARRISONDODDRIDG

E

WETZEL

MARSHALL

OHIO

BROOKE

HANCOCK

TYLER

PLEASANTS

WOOD

JACKSON

RITCHIE

WIRT

ROANE

CALHOUNGILMER

LEWIS

UPSHUR

BARBOURTUCKER

GRANT

MINERALHAMPSHIRE

MORGAN

BERKELEY

JEFFERSON

HARDY

PENDLETON

RANDOLPH

WEBSTER

BRAXTON

POCAHONTASNICHOLAS

CLAY

GREENBRIERFAYETTE

RALEIGH

SUMMERS MONROE

MERCERMCDOWELL

WYOMING

MINGO

LOGAN

BOONE

KANAWHA

PUTNAM

MASON

CABELL

WAYNE LINCOLN

VI

VIII

VII

I

V

IIIII

IV

RESA Regions

Coordinated School Wellness Programs

PRESTON

MONONGALIA

ROANE

CALHOUNGILMER

WEBSTER

BRAXTON

NICHOLAS

CLAY

Kathryn Greenlief - 304-276-4052Program Manager - Northernkgreenlief@hsc.wvu.edu

16+

DODDRIDGE

WETZEL

MARSHALL

OHIO

BROOKE

HANCOCK

TYLER

PLEASANTS

RITCHIE

WIRT

Dalena Riggs - 304-692-6741driggs2@hsc.wvu.edu

TUCKER

GRANT

MINERALHAMPSHIRE

MORGAN

BERKELEY

JEFFERSON

HARDY

PENDLETON

Robin VanFleet - 304-692-6743rvanfleet@hsc.wvu.edu

FAYETTE

RALEIGH

KANAWHA

Tammy Pyle-Vicars - 304-812-4469Program Manager - Southerntpyle@hsc.wvu.edu

WOOD

JACKSON

PUTNAM

MASON

CABELL

WAYNE LINCOLN

Tina Whitt - 304-593-4319twhitt@hsc.wvu.edu

GREENBRIER

Nahied Haidar - 304-293-4286Greenbrier CHOICES Projectnhaidar@hsc.wvu.edu

MARION

TAYLOR

BARBOUR

Valerie Minor - 304-457-6350vminor@hsc.wvu.edu

CARDIAC2012-2013

LEWIS

UPSHURRANDOLPH

POCAHONTAS

HARRISON

SUMMERS MONROE

MCDOWELL

WYOMING

MINGO

LOGAN

BOONE

Janetta Massie - 304-890-9490jmassie@hsc.wvu.edu

MERCER

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

Eloise Elliott PhD Emily Jones Ph.D.

Sean Bulger ED.D

School of Public Health Colleagues

Alfgeir L. Kristjansson Ph.D. Christa Lilly Ph.D.