Screening of the coronary prone by study of offspring.

All the authors are or were, at the time of the study, with the School of Medicine, State University of New York at Bufjalo. Dr. Ibrahim is Deputy Health Commissioner of Erie County, N.Y., and associate professor of epidemiology in the school's department of social and preventive medicine. Dr. Borden is now a resident in radiology, Boston City Hospital, and Dr. Pinsky is in private practice in Philadelphia, Pa. Dr. Kohn is clinical associate professor of medicine, in the school of medicine. Mr. Feldman is research associate in biostatistics in the school's department of social and preventive medicine. Dr. Winkelstein is professor of epidemiology, University of California School of Public Health, Berkeley. The study described in this paper was partly supported by New York State Health Department grant 67267 and grants from the Heart Association of Erie County. Tearsheet requests to Michel A. Ibrahim, M.D., 2211 Main Street, Bufialo, N.Y. 14214. THE INCREASED likelihood of coronary heart disease developing in persons with elevated levels of serum cholesterol, blood pressure, body weight, and certain electrocardiographic abnormalities has been repeatedly shown in retrospective and prospective studies (1). Other studies have revealed significant associations between fathers and their children for cholesterol and blood pressure levels and ponderal index values (2-4). These observations raise the question of whether it is possible to identify or screen coronary-prone middle-aged men by studying their children. To evalute this procedure, the so-called coronary risk factors should be measured on both fathers and children. The frequency of predicting the presence of coronary heart disease factors among fathers by examining their children's values for these characteristics could then be quantified. Furthermore, if such a procedure were to be practical, a "captive" population of children whose fathers are at risk should be selected. Eleventh grade students seem to be ideal for this purpose as they are a captive, relatively stable population, and their fathers are mostly 35 to 55 years old. The feasibility of such a procedure was demonstrated in a pilot project involving 100 studentfather pairs (2). Briefly, the pilot study revealed significantly positive associations between the students and their fathers for serum cholesterol and blood pressure levels and ponderal index values. In addition, predominantly high levels of all variables combined (blood lipids, blood pressure, glucose, uric acid, skinfold thickness, and ponderal index) of the students predicted all the fathers with ST-T abnormalities. Also, three-fourths of the fathers with a history of coronary heart disease or with elevated levels of relative body mass and two-thirds of the