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Biomedical subjects

J S Viikari

Publications and source records attributed to J S Viikari.

At least 55 records · Page 3Linked to original sources
PubMed1995

The role of insulin in clustering of serum lipids and blood pressure in children and adolescents. The Cardiovascular Risk in Young Finns Study.

In adults hyperinsulinaemia is associated with an atherogenic risk profile including obesity, low levels of HDL-cholesterol, high levels of triglycerides and elevated blood pressure. To examine these associations in the young we studied the cross-sectional relationships of insulin with obesity indices (body mass index, subscapular skinfold thickness), serum lipids and blood pressure in 1,865 children, adolescents and young adults aged 6-24 years. We also used longitudinal data to study the value of a single insulin measurement to predict high risk factor levels and clustering of multiple risk factors after a 6-year follow-up. In cross-sectional analyses the levels of triglycerides, HDL-cholesterol, systolic blood pressure and obesity indices were usually significantly different across the quartiles of fasting insulin in both sexes among children, adolescents and young adults. In general, no associations were seen with total cholesterol or LDL-cholesterol. In prospective analysis elevated baseline insulin was related to the incidence of hypertriglyceridaemia (> or = 95th percentile) at the follow-up. This relationship persisted even after adjustments for baseline obesity or 6-year change in obesity status. Moreover, baseline insulin concentration was higher in subjects who subsequently showed clustering of high triglycerides, low HDL-cholesterol and high systolic blood pressure levels at the follow-up. We conclude that high fasting insulin levels measured in children and adolescents predict the development of hypertriglyceridaemia years later. In addition, high insulin levels seem to precede the development of a potentially atherogenic risk factor profile including low HDL-cholesterol, high triglycerides and high systolic blood pressure.

Adolescent↗
PubMed1995

Tracking of serum lipids in children; association with the absolute lipid level--the cardiovascular risk in young Finns study.

We studied tracking of serum lipids in children and young adults (n = 248) during a 12-year follow-up. A novel method was developed for assessing tracking. It was based on the calculation of the absolute width of the individual track consisting of 5 serum lipid determinations. The total cholesterol (TC) track width tended to be broader in females compared to males (1.33 versus 1.24 standard deviation (SD) units). Approximately 35, 39, 24 and 13% of subjects had all 5 measurements within 1 SD (of the cohort mean) from serum TC, low density lipoprotein cholesterol, high density lipoprotein cholesterol and triglycerides, respectively. However, variations in excess of 2.5 SDs were not rare. We also assessed the dependence of tracking on the absolute lipid level by calculating the SD of the standardized 6-year change in a cohort of 2236 children. In each serum lipid variable studied, lowest degree of tracking was found in highest lipid values. The mean changes were also largest in extreme values due to regression toward mean phenomenon. Our findings indicate that the width of longitudinal track of serum lipids may be two wide to reliably detect high risk children. Further, the track width was even broader in subjects with extreme serum lipid values.

Adolescent↗
PubMed1995

Habitual diet, platelet function, fibrinogen and factor VII coagulant activity in young Finns.

OBJECTIVES: The objective of the study was to determine whether an association between diet and platelet function, plasma fibrinogen level and factor VII coagulant activity (VII:C) could be established in young subjects. DESIGN: Data on the habitual diet of the subjects were collected either by a questionnaire on food habits (n = 204) or by a 48-h dietary recall interview (n = 53). SUBJECTS: The subjects were participants in the project 'Cardiovascular Risk in Young Finns' (age range 15-30 years). A total of 204 subjects having a questionnaire on food habits participated in the platelet function tests and 53 also participated in a 48-h dietary recall interview. Plasma fibrinogen concentration and factor VII: C were measured from 79 subjects. MAIN OUTCOME MEASURES: Platelet function was tested by turbidometric measurement of platelet aggregation using ADP and collagen as aggregation agents. RESULTS: Platelet aggregation with ADP (at up to 4.0 mumol L-1) and collagen (at up to 5.0 micrograms mL-1 platelet-rich plasma PRP) showed that the diet characterized as 'saturated', i.e. containing high-fat milk and saturated fat, was associated with platelets less sensitive to aggregating agents in vitro when compared to the unsaturated type of diet. Collagen- but not ADP-induced aggregation decreased with age of the subjects (P = 0.026-0.057, regression coefficient). An inverse regression coefficient between plasma factor VII:C (101%; range 64-145%) and serum triglycerides (P = 0.006) and the intake of rye (g 1000 kcal-1; P = 0.03) were found. CONCLUSIONS: In this study we showed that platelet reactivity and factor VII:C already differ considerably between subjects at a young age, and diet may explain some of this variation.

Adolescent↗
PubMed1995

Influence of oral contraceptive use on lipoprotein (a) and other coronary heart disease risk factors.

We have studied the influence of oral contraceptive use on lipoprotein (a) levels in a cohort of women aged 18, 21 and 24 years (n = 559). Data was available on oral contraceptive formulation and dosage, anthropometric variables, exercise, serum lipoprotein (a), insulin, lipid and apolipoprotein levels. Lipoprotein (a) was determined by radioimmunoassay. Differences were assessed with non-parametric statistical methods. Forty per cent of the study women used oral contraceptives. The use of desogestrel-containing monophasic preparations was associated with lower levels of lipoprotein (a) compared to triphasic/levonorgestrel formulations or to non-users (P = 0.005). This effect was seen only in non-smoking women. Oral contraceptive users had higher levels of serum apolipoprotein B, HDL3-cholesterol, apolipoprotein A-I, triglycerides and systolic blood pressure, and lower serum lecithin:cholesterol acyltransferase activity. Lifestyle factors (smoking, exercise) showed no significant influence on lipoprotein levels. In conclusion, the use of desogestrel-containing oral contraceptives has a marked lowering effect on lipoprotein levels. Prospective studies will be needed to assess the net influence of oral contraceptive use on cardiovascular health.

Adolescent↗
PubMed1995

Molecular characterization of minor gene rearrangements in Finnish patients with heterozygous familial hypercholesterolemia: identification of two common missense mutations (Gly823-->Asp and Leu380-->His) and eight rare mutations of the LDL receptor gene.

Two deletions of the low-density lipoprotein (LDL) receptor gene were previously shown to account for about two thirds of all mutations causing familial hypercholesterolemia (FH) in Finland. We screened the DNA samples from a cohort representing the remaining 30% of Finnish heterozygous FH patients by amplifying all the 18 exons of the receptor gene by PCR and searching for DNA variations with the SSCP technique. Ten novel mutations were identified, comprising two nonsense and seven missense mutations as well as one frameshift mutation caused by a 13-bp deletion. A single nucleotide change, substituting adenine for guanidine at position 2533 and resulting in an amino acid change of glycine to aspartic acid at codon 823, was found in DNA samples from 14 unrelated FH probands. This mutation (FH-Turku) affects the sequence encoding the putative basolateral sorting signal of the LDL receptor protein; however, the exact functional consequences of this mutation are yet to be examined. The FH-Turku gene and another point mutation (Leu380-->His or FH-Pori) together account for approximately 8% of the FH-causing genes in Finland and are particularly common among FH patients from the southwestern part of the country (combined, 30%). Primer-introduced restriction analysis was applied for convenient assay of the FH-Turku and FH-Pori point mutations. In conclusion, this paper demonstrates the unique genetic background of FH in Finland and describes a commonly occurring FH gene with a missense mutation closest to the C terminus thus far reported.

Base Sequence↗
PubMed1994

Tracking and predictiveness of serum lipid and lipoprotein measurements in childhood: a 12-year follow-up. The Cardiovascular Risk in Young Finns study.

The authors analyzed tracking and predictiveness of serum lipid and lipoprotein measurements in Finnish children and young adults over a 12-year follow-up period. A representative sample of 3,596 healthy subjects aged 3-18 years was examined in 1980. The follow-up studies were done in 1983, 1986, 1989, and 1992. Data were available on serum lipids and lipoproteins, anthropometric measurements, dietary and smoking habits, and use of oral contraceptives. Complete data on serum lipids in 1980 and 1992 were available for 883 subjects (47% males), and they comprised the study cohort for this analysis. Significant tracking was found in each of the serum lipid variables studied. The range of 12-year correlations was 0.48-0.58, 0.53-0.58, 0.53-0.58, 0.57-0.59, and 0.33-0.37 for serum total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, the LDL:HDL cholesterol ratio, and triglycerides, respectively. Males showed more tracking than females; there was no clear age trend. Tracking of HDL2 cholesterol was better than that of HDL3 cholesterol (0.64 vs. 0.43, respectively; 3-year tracking). Apolipoproteins A-I and B showed similar amounts of tracking compared with HDL and LDL cholesterol, respectively. Approximately 50% of subjects who initially fell into the extreme quintiles of total cholesterol, LDL cholesterol, and HDL cholesterol were in the same quintiles after 12 years. In multiple regression analyses, childhood obesity, exercise, diet, and smoking habits did not markedly aid the prediction of adult serum lipid values. However, the use of two childhood measurements increased the amount of adult serum lipid variability explained. Although universal screening cannot be endorsed, these findings emphasize the importance of serum lipid measurements in the early detection of familial lipoprotein disorders and in the initial evaluation of coronary heart disease risk in childhood.

Adolescent↗
PubMed1994

Effects of persistent physical activity and inactivity on coronary risk factors in children and young adults. The Cardiovascular Risk in Young Finns Study.

The tracking of physical activity and its influence on selected coronary heart disease risk factors were studied in a 6-year (original survey in 1980, with follow-ups in 1983 and 1986) study of Finnish adolescents and young adults as part of the Cardiovascular Risk in Young Finns Study. The subjects in this analysis were aged 12, 15, and 18 years at baseline. Physical activity was assessed with a standardized questionnaire, and a sum index was derived from the product of intensity, frequency, and duration of leisure time physical activity. Complete data on physical activity index from each study year were available on 961 participants. Significant tracking of physical activity was observed with 3-year correlations of the index ranging from 0.35 to 0.54 in boys and from 0.33 to 0.39 in girls. Tracking was better in older age groups. Two groups of adolescents (active and sedentary groups) were formed at baseline according to high and low values of the index, respectively. Approximately 57% of those classified as inactive remained inactive after a 6-year follow-up. The corresponding value for active subjects was 44% (p < 0.01, active vs. inactive). The long-term effects of physically active and sedentary life-styles were studied by comparing groups of young adults who had remained active or inactive in every three examinations. Serum insulin and serum triglyceride concentrations were significantly lower in active young men. They had a more beneficial high density lipoprotein to total cholesterol ratio and thinner subscapular skinfolds. Among young women, significant differences were seen in adiposity (subscapular skinfold) and in serum triglyceride concentration. Physical activity was also related to less smoking in both sexes and, among young men, to lower consumption of saturated fatty acids and to higher polyunsaturated to saturated fatty acids ratio of the diet. In regression analyses adjusted for the 6-year change in obesity, smoking status, and diet, the change in physical activity was inversely associated with changes in serum insulin and triglycerides in boys. Independent association with triglycerides disappeared when insulin change was added to the model, suggesting that the effect may partly be mediated through insulin metabolism. The authors conclude that the level of physical activity tracks significantly from adolescence to young adulthood. Physical inactivity shows better tracking than does physical activity, and subjects who are constantly inactive express a less beneficial coronary risk profile compared with those who are constantly active.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1994

Short-term intra-individual variation and long-term tracking of serum lipid levels in children: the Cardiovascular Risk in Young Finns Study.

We have studied the short-term intra-individual variation and long-term tracking until early adulthood of serum total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol and triglyceride levels in 9-year-old Finnish boys. The study was based on two different cohorts; one to study short-term tracking and another to study long-term tracking. The short-term tracking cohort consisted of 57 healthy Finnish 9-year-old boys with serum lipid determinations 2 and 7 days apart in 1984. The other cohort consisted of 40 healthy Finnish 9-year-old boys and the serum lipid determinations were made in 3-year intervals from 1980 to 1989. Tracking was expressed as Spearman's rank order correlation coefficients between subsequent measurements. Tracking was weaker as the time between measurements became longer. For serum total cholesterol the correlation coefficients were 0.92, 0.77, 0.70, 0.73, and 0.59 for measurements made 2 days, 7 days, 3 years, 6 years, and 9 years apart, respectively. Other lipid variables behaved quantitatively in a similar manner. The dependence of tracking on time was not linear. The greatest relative decrease in correlations took place during the determination periods of 2 and 7 days, whereafter the decline was only moderate. In conclusion, short-term intra-individual variation of serum lipid levels in children, which is mainly due to biological variation, has a major influence on their long-term tracking. Our findings emphasize the need for several independent serum lipid determinations, performed at least one week apart, in the assessment of a child's true serum lipid level.

Cardiovascular Diseases↗
PubMed1994

Relations of life-style with lipids, blood pressure and insulin in adolescents and young adults. The Cardiovascular Risk in Young Finns Study.

The associations of life-style variables, namely type of dietary fat, alcohol use, smoking, obesity, physical activity and oral contraceptive use with serum lipids, insulin and blood pressure were studied in 1398 adolescents and young adults aged 15-24 years. Smokers were more often physically inactive and regular users of alcohol compared to non-smokers. In females, smoking and alcohol use were more prevalent among oral contraceptive users. Independent effects of life-style variables on lipids, blood pressure and insulin were assessed with multiple linear regression models. In both sexes, body mass index was positively related to low density lipoprotein cholesterol (LDL-C), triglycerides (TG), systolic (SBP) and diastolic (DBP) blood pressure and insulin, and negatively with high density lipoprotein cholesterol (HDL-C). Leisure time physical activity was associated with lower levels of insulin among males. Smoking was related with 0.07 mmol/l lower HDL-C levels and about 0.09 mmol/l higher TG levels in males. In both sexes, smoking was related with lower levels of SBP. In males, alcohol use was associated with 0.05 mmol/l higher level of HDL-C (P = 0.06). In females, alcohol use was associated with lower levels of LDL-C and TG. Oral contraceptive use was associated with approximately 0.15 mmol/l higher levels of TG and about 4.0 mmHg higher SBP. Preferring butter over margarine as dietary fat was associated with 0.26 and 0.19 mmol/l higher levels of LDL-C in males and females, respectively. Accumulation of adverse life-habits contributed to the clustering of an atherogenic lipid profile and high blood pressure. In males, those with 4 selected life-habits present, namely obesity, smoking, inactivity and the use of butter, had 5.5 times greater risk (95% confidence interval 1.4-20.7) of belonging to the group with high LDL-C, low HDL-C and high DBP compared to those with zero or one life-habits present. These data demonstrate that life-habits show clustering in adolescents and young adults. Individuals with many adverse life-style risk factors present are at increased risk of having an atherogenic lipid and blood pressure profile.

Adolescent↗
PubMed1994

Clustering and six year cluster-tracking of serum total cholesterol, HDL-cholesterol and diastolic blood pressure in children and young adults. The Cardiovascular Risk in Young Finns Study.

Clustering and tracking of serum total cholesterol, high-density lipoprotein cholesterol (HDL-C) and diastolic blood pressure were studied in children and young adults. "High-risk" individuals were defined as those having these risk factors at the age and sex specific upper tertile (lowest tertile for HDL-C). Among older boys risk factors occurred at adverse levels more often than expected by chance. Cluster-tracking was assessed as the probability of remaining in the extreme tertiles during follow-up. Approximately 25% of subjects initially at "risk" remained there for 6 years. Subjects who became high-risk individuals during the follow-up expressed greater increase in obesity indices, started to consume more saturated fat and cholesterol and became physically active less often compared to those subjects who were initially at risk, but no longer at the follow-up.

Adolescent↗
PubMed1994

Should children or young adults be screened for serum lipid levels to prevent adult coronary heart disease? Experience from the Cardiovascular Risk in Young Finns study.

Coronary heart disease (CHD) has its origin in childhood. High cholesterol levels measured in children and adolescents are indicative of concurrent atherosclerotic changes and probably predict adult coronary heart disease. We review here the relevance of screening children, adolescents or young adults for serum lipid levels in order to efficiently prevent premature adult coronary heart disease. Data is presented in the light of the large Cardiovascular Risk in Young Finns study and other studies. The authors do not recommend universal screening strategies because of (i) the limited predictive power of serum lipid levels on an individual level, (ii) the limited knowledge on the safety of interventive measures on the growing child, and (iii) the limited knowledge on the ethical aspects of screening (labelling). However, the importance of measuring serum lipids to detect familial dyslipidaemic disorders such as familial hypercholesterolaemia, is stressed. The selection of children or adolescents for serum lipid measurements should be made on the basis of family history of early CHD or dyslipidaemia.

Adolescent↗
PubMed1994

Limited joint mobility in type 1 diabetic patients: correlation to other diabetic complications.

OBJECTIVES: To examine the association between limited joint mobility (LJM) and complications of diabetes in adult patients with type 1 diabetes. DESIGN: Cross-sectional study in diabetic patients and healthy controls. SETTING: The study was performed at the department of medicine in Turku University Hospital (n = 103), a private diabetes outpatient clinic (n = 153) and the municipal health centre of Turku (n = 29), Finland. SUBJECTS: We studied 285 diabetic patients [age (mean +/- SD): 33.4 +/- 10.0 years] and 288 healthy nondiabetic controls [age (mean +/- SD): 32.3 +/- 9.2]. MAIN OUTCOME MEASURES: The limitations of several joints were examined with a goniometer. The diabetic patients were assessed in terms of the following complications: background and proliferative retinopathy, peripheral symmetrical polyneuropathy, autonomic neuropathy, impotence as well as clinical and incipient nephropathy; serum lipid values were also measured. RESULTS: The prevalences of LJM were 58% and 14% in diabetic patients and in healthy controls, respectively. The diabetic patients with LJM had a 2.8-fold risk of proliferative retinopathy [95% confidence interval (CI): 1.1-7.3] and a 3.6-fold risk of nephropathy (95% CI: 1.4-9.3) compared to patients without LJM, when the confounding effect of the duration of diabetes was excluded. LJM was not related to metabolic control of diabetes, microalbuminuria, autonomic neuropathy or impotence. The association between LJM and peripheral symmetrical polyneuropathy was exclusively explained by the duration of diabetes. The correlation between LJM and serum total and low-density lipoprotein cholesterol was dependent on the association between LJM and nephropathy. LJM did not relate to serum high-density lipoprotein cholesterol or triglyceride values. CONCLUSIONS: The diabetic patients with LJM had an increased risk of proliferative retinopathy and nephropathy compared to patients without LJM.

Adolescent↗
PubMed1994

Variability gene effects of DNA polymorphisms at the apo B, apo A I/C III and apo E loci on serum lipids: the Cardiovascular Risk in Young Finns Study.

We studied the influence of selected genetic markers on the intra-individual long-term variability in serum lipid levels. The study cohort consisted of a sub-sample from a large follow-up study of atherosclerosis precursors in children and young adults. A total of 320 subjects had determinations of apo B XbaI RFLP genotypes, 305 subjects had apo AI/CIII SstI RFLP genotype determinations and 1581 subjects had their apo E phenotypes determined. Complete data on serum lipids were available at 3-year intervals over a 6-year follow-up period. The subjects were healthy and aged 3-18 years at baseline. Intra-individual variability was assessed with a nested analysis of variance procedure. Each of the genetic markers studied here significantly affected intra-individual variability of serum lipid levels. No clear sex influence was observed, although the differences in variability tended to be more significant in males. Apo B XbaI genotypes significantly influenced intra-individual variability of total and LDL-cholesterol levels in both sexes. A marked effect of the XbaI genotype was also found on triglyceride variability. In males the standardized intra-individual triglyceride variances were 0.71 and 0.34 in genotypes X1X1 and X2X2, respectively (p < 0.001), with a clear gene dosage effect. The apo AI/CIII genotype had an influence only on the variability of total cholesterol and LDL-cholesterol levels and only in males. The apo E phenotypes were associated with intra-individual variability in total and LDL-cholesterol levels but again, only in males.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Lipoprotein (a) levels in children and young adults: the influence of physical activity. The Cardiovascular Risk in Young Finns Study.

A high lipoprotein(a) (Lp(a)) level is an independent and predominantly genetically determined risk factor for coronary heart disease and other vascular diseases. We studied the levels of Lp(a) and the influence of physical activity on Lp(a) in the young Finnish population. The study cohort comprised children and young adults aged 9, 12, 15, 18, 21 and 24 years (n = 2464) participating in a large multicenter follow-up study of cardiovascular risk factors in children and young adults. Data were available on physical activity, anthropometric variables, serum Lp(a), insulin and lipid levels. A physical activity index was calculated based on several physical activity variables. Lp(a) was determined by radioimmunoassay with a detection threshold of 3 mg/dl. Differences were assessed with non-parametric statistical analyses. The observed range of Lp(a) was from < 3 to 90.8 mg/dl. The distribution of Lp(a) was highly skewed as 88% of the population (89% males and 87% females) had Lp(a) concentrations less than 25 mg/dl. A total of 35% of the subjects had Lp(a) levels less than 3 mg/dl. There were no significant differences in Lp(a) levels with respect to age or gender. The serum concentration of Lp(a) was statistically significantly correlated with the level of physical activity. Other behavioral variables studied did not have a significant contribution to the variability of Lp(a) levels. These results demonstrate that levels of Lp(a) are not related to age, gender or many of the known coronary heart disease risk factors. However, physical activity is associated with favorable Lp(a) levels, as high levels of Lp(a) (> 25 mg/dl) were less frequent in the physically most active subjects.

Adolescent↗
PubMed1994

Age and gender specific serum lipid and apolipoprotein fractiles of Finnish children and young adults. The Cardiovascular Risk in Young Finns Study.

We present fractile data on serum lipids and apolipoproteins A-l and B for children and young adults from the cardiovascular risk in young Finns study cohort of 1986. The sample comprised 2370 fasting children and young adults (1114 males and 1256 females) aged 9, 12, 15, 18, 21 and 24 years. The determinations were performed in duplicate with standard methods. LDL-cholesterol values were calculated. The limits for clearly pathological values (exceeding the 97.5th percentile) irrespective of age and gender were 7.5 mmol/l, 5.0 mmol/l, 3.5 mmol/l and 1.4 g/l for serum total cholesterol, LDL-cholesterol, triglycerides and apolipoprotein B, respectively. Corresponding values (below the 2.5th percentile) for HDL-cholesterol, apolipoprotein A-l, HDL2- and HDL3-cholesterol were 0.80 mmol/l, 1.0 mg/l, 0.20 mmol/l and 0.70 mmol/l, respectively. Approximately 79%, 33% and 7% of males had serum total cholesterol values greater than 4.0 mmol, 5.0 mmol/l and 6.0 mmol/l, respectively. Corresponding percentages for females were 87%, 43% and 10%. However, age-related differences were marked. The prevalence of values, e.g. greater than 6 mmol/l according to age, ranged from 6 to 13% in females and from 3 to 12% in males, emphasizing the need for age-specific reference values. Additionally, postpubertal values for total and LDL-cholesterol tended to be slightly lower compared to prepubertal values, indicating that the reference values for adults do not apply to adolescents and young adults. The age-related changes in lipid levels were evident in each fractile and were especially accentuated in higher fractiles. Fluctuations with age were more pronounced in males than in females. These results are intended to be applied as reference values for diagnosing dyslipidemias.

Adolescent↗
PubMed1994

Clustering of risk factors for coronary heart disease in children and adolescents. The Cardiovascular Risk in Young Finns Study.

Clustering of selected coronary heart disease (CHD) risk factors was studied in a cohort of 3457 children and adolescents, aged 3-18 years. Subjects were defined as "high-risk" individuals if their values for serum LDL cholesterol, systolic blood pressure and obesity index (sum of biceps, triceps and subscapular skinfolds) exceeded the age- and gender-specific 75th percentile of the present study cohort. Clustering was studied by using the observed/expected ratio (O/E ratio). Statistically significant clustering was observed as 3.1% of all subjects belonged to the high-risk group (O/E ratio = 2.0, p < 0.001). Under the assumption of no association, only 1.56% would have been expected. Clustering was stronger in boys (3.6%) than in girls (2.6%). When other lipid variables (total cholesterol, HDL cholesterol, triglycerides) or obesity indices (subscapular, biceps, triceps skinfolds, the subscapular/triceps ratio and BMI) were used in the analyses, the degree of clustering remained essentially the same. The tendency of risk factors to cluster increased with age in boys, whereas in girls the strongest clustering was usually seen in the age group 9-12 years. When a fourth risk factor (low HDL cholesterol) was added to the analyses, the tendency of risk factors to occur simultaneously became even greater. Aggregation of multiple risk factors was strongest in boys who presented the highest levels of these risk factors. Common risk factors for CHD cluster in children and adolescents. The gender differences observed here may partly explain why males develop CHD more often than females in adulthood.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗