Pediatric Markers of Adult Cardiovascular Disease

Cardiovascular disease (CVD) is the leading cause of mortality in the United States [1]. Atherosclerotic CV events do not occur until adulthood, except in the context of rare genetic disorders such as homozygous familial hypercholesterolemia. However, the atherogenic process that leads to CVD begins in childhood and progresses throughout the lifespan [2]. The degree of atherosclerosis early in life is associated with established risk factors for CVD (e.g. family history, obesity, dyslipidemia), indicating that the development and progression of atherosclerosis in childhood is driven by genetic as well as environmental factors. Therefore, although CV events do not occur in childhood, establishing heart healthy behaviors and managing CV risk factors in childhood may prevent or delay the development of atherosclerosis and, in turn, reduce the risk of CVD later in life. The purpose of this review is to 1) outline the evidence that atherosclerosis begins in childhood, 2) identify the risk factors associated with childhood atherosclerosis, and 3) identify the risk factors present in childhood that are associated with adult CVD. The information presented in this review will lay the foundation for the pediatric origins of CVD and conceptually support primordial and primary prevention strategies to reduce the overall burden of CVD.