Prevention of atherosclerosis from childhood

Cardiovascular diseases caused by atherosclerosis do not typically manifest before middle age; however, the disease process begins early in life. Preclinical atherosclerosis can be quantified with imaging methods in healthy populations long before clinical manifestations present. Cohort studies have shown that childhood exposure to risk factors, such as dyslipidaemia, elevated blood pressure and tobacco smoking, are associated with adult preclinical atherosclerotic phenotypes. Importantly, these long-term effects are substantially reduced if the individual becomes free from the risk factor by adulthood. As participants in the cohorts continue to age and clinical end points accrue, the strongest evidence linking exposure to risk factors in early life with cardiovascular outcomes has begun to emerge. Although science has deciphered the natural course of atherosclerosis, discovered its causal risk factors and developed effective means to intervene, we are still faced with an ongoing global pandemic of atherosclerotic diseases. In general, atherosclerosis goes undetected for too long, and preventive measures, if initiated at all, are inadequate and/or come too late. In this Review, we give an overview of the available literature suggesting the importance of initiating the prevention of atherosclerosis in early life and provide a summary of the major paediatric programmes for the prevention of atherosclerotic disease. We also highlight the limitations of current knowledge and indicate areas for future research. In this Review, Raitakari and colleagues discuss the importance of initiating the prevention of atherosclerosis in early life and summarize the major paediatric programmes for the prevention of atherosclerotic cardiovascular disease.

Automated summary

Atherosclerosis, a major cause of cardiovascular disease, begins early in life even though clinical manifestations are typically not present before middle age. Childhood exposure to risk factors, such as dyslipidaemia, elevated blood pressure, and tobacco smoking, are associated with adult preclinical atherosclerosis. However, if these risk factors are eliminated in adulthood, the long-term effects are substantially reduced. Preventive measures for atherosclerosis are often inadequate or initiated too late. Initiating prevention in early life is crucial for combating the ongoing global pandemic of atherosclerotic diseases.