Early origins of heart disease: low birth weight and determinants of cardiomyocyte endowment

Summary 1. World-wide epidemiological and experimental animal studies demonstrate that adversity in fetal life, resulting in intrauterine growth restriction (IUGR), programs the offspring for a greater susceptibility to ischemic heart disease and heart failure in adult life. 2. After cardiogenesis, cardiomyocyte endowment is determined by a range of hormones and signalling pathways that regulate cardiomyocyte proliferation, apoptosis and the timing of multinucleation/terminal differentiation. 3. The small fetus may have reduced cardiomyocyte endowment due to the impact of suboptimal intrauterine environment on the signalling pathways that re gulate cardiomyocyte proliferation, apoptosis and the timing of terminal differentiation.