Cholesterol as a risk factor for early atherosclerosis: the Bogalusa Heart Study

Abstract

Evidence that atherosclerosis and its major sequela, coronary artery disease, begin in childhood is firmly based on the findings from studies in the areas of epidemiology, pathology, clinical pediatrics and genetics. These studies confirm that atherosclerosis is a life-long process that starts very early in life. Serum cholesterol and its distribution in lipoprotein fractions are important risk variables that need to be evaluated in childhood and these are strongly associated with initial stages of atherosclerotic disease. Since childhood cardiovascular risk factors persist or track into adulthood, the life-long burden of a dyslipidemic trait and concomitant conditions, such as obesity and high blood pressure, has a major impact on the silent phase of subclinical disease that progresses on to clinical events in adulthood. Consumption of a high-energy, saturated fat diet in combination with a sedentary life-style and tobacco use are the principle modifiable contributors to atherosclerosis. These interact with the intrinsic genetic make-up to begin the life-long burden of cardiovascular risk. For these reasons, heart disease needs to be addressed at the pediatric age. A public health strategy of health education of children provides an important basis for prevention.