Cardiovascular risk begins in childhood: a time for action.

p eart disease is the major cause of death worldwide. Pediatric cardiovascular epidemiologic studies over the past 4 decades have clearly hown that precursors of coronary artery disease, hyertension, and type 2 diabetes all originate in childood. Further, cardiovascular risk factors, evidence of ubclinical, asymptomatic cardiovascular lesions, can be iagnosed early in life. What is also evident is that the evelopmental occurrence of heart disease represents oth genetic and environmental determinants. Factors uch as obesity and tobacco smoke are preventable, hile family history can be dealt with only by undertanding and controlling risk factors. The autopsy findings in The Bogalusa Heart Study nd Pathobiological Determinants of Atherosclerosis in outh showed a strong relationship of vascular disease o traditional cardiovascular risk factors. These obserations provided irrefutable evidence of the imporance of cardiovascular diseases and associated risk actors beginning in youth. The autopsy findings of a ery high prevalence of coronary artery lesions in oldiers in the Korean and Vietnam wars gave credence o the occurrence of early onset of heart disease roadly in Westernized populations. Geoffrey Rose has efined this phenomenon elegantly and with foresight s “sick individuals and sick populations.” Although recommendations to address childhood isk factors have been made for 30 years, such recomendations have remained insufficiently implemented n clinical and public health practices. The current pidemic of obesity and its consequences are the best vidence of our failure. The papers in this supplement to the American Journal f Preventive Medicine, based on Project HeartBeat! ave the important message of the need and how to ddress the cardiovascular health of children. Current ecommended guidelines and implementations for edical care are stated to be “evidence-based.” This ompilation of research on children and adolescents rovides the evidence base for action. A Time for Action rom the WHO, with the book’s senior author, Darwin abarthe, set the stage to show the urgent need to