Childhood Precursors of High Blood Pressure and Elevated Cholesterol

Abstract

For several decades, high blood pressure and elevated cholesterol have been established as risk factors for atherosclerosis and, thus, for most cardiovascu­ lar morbidity and mortality of industrialized countries. More recently, de­ veloping countries are recognizing the public health burden of high blood pressure and elevated cholesterol, as a result of demographic changes, which have seen increasing proportions of populations reach the sixth decade of life and beyond, and social and behavioral changes, which have fostered the development of the risk factors (12). Thus, the consequences of high blood pressure and elevated cholesterol, in addition to cigarette smoking and other factors, now constitute a global public health problem. The causes of coronary heart disease and other complications of atheroscle­ rosis and hypertensive disease must be sought earlier in life than the age range in which these events become especially common, i.e. at age 40 and older. The theoretical foundation for this concept is reinforced strongly by patholog­ ical evidence, including that from postmortem examinations of young military casualties. These examinations show that the vascular lesions of atherosclero­ sis commonly are present in the coronary arteries and aorta before age 20 (see, for example, Ref. 40). Geographically widespread evidence that aortic