When to prevent cardiovascular disease? As early as possible: lessons from prospective cohorts beginning in childhood.
OBJECTIVE
To detail recent developments linking modifiable youth risk factors with preclinical markers of cardiovascular disease such as carotid artery intima-media thickness, pulse-wave velocity (PVW) and large artery stiffness, brachial artery flow-mediated dilatation, left ventricular geometry, and coronary artery calcification in adulthood.


RESULTS
Population-based data from prospective cohort studies beginning in youth with follow-up into adulthood have shown that the modifiable youth risk factors of elevated blood lipids, blood pressure, and adiposity, smoking (active and passive), metabolic disorders, physical inactivity, low cardiorespiratory fitness, and diet associate with preclinical markers of cardiovascular disease in adulthood. The data suggest that, in some instances, those who amend their trajectory by not maintaining these risk factors into adulthood experience reductions in preclinical markers to levels associated with never having had the risk factor.


CONCLUSIONS
Though avoidance of risk factors in youth is ideal, there is still a window for intervention where long-lasting cardiovascular effects might be avoided. Health-enhancing changes in the rates of active and passive smoking, adiposity, increased physical activity, accentuated fitness, modified diet, and socioeconomic position in the transition from youth to adulthood might be important in modifying an individual's trajectory from high risk in youth to low risk in adulthood.
Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia. cmagnuss@utas.edu.au
Costan G
CG
Magnussen
Kylie J
KJ
Smith
Markus
M
Juonala
D000293:Adolescent; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D059168:Carotid Intima-Media Thickness; D002648:Child; D015331:Cohort Studies; D004032:Diet; D006801:Humans; D006949:Hyperlipidemias / Q000517:prevention & control / Q000628:therapy; D006973:Hypertension / Q000517:prevention & control / Q000628:therapy; D007333:Insulin Resistance; D024821:Metabolic Syndrome / Q000517:prevention & control / Q000628:therapy; D009765:Obesity / Q000517:prevention & control / Q000628:therapy; D050177:Overweight / Q000517:prevention & control / Q000628:therapy; D011446:Prospective Studies; D063177:Pulse Wave Analysis; D040242:Risk Reduction Behavior; D057185:Sedentary Behavior; D012907:Smoking / Q000628:therapy; D000074606:Smoking Prevention; D014028:Tobacco Smoke Pollution / Q000517:prevention & control; D059289:Vascular Stiffness; D014664:Vasodilation
D014028:Tobacco Smoke Pollution