Korean Circ J.  2010 Jan;40(1):1-9. 10.4070/kcj.2010.40.1.1.

Atherosclerotic Cardiovascular Disease Beginning in Childhood

  • 1Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea. hongym@chollian.net


Although the clinical manifestations of cardiovascular disease (CVD), such as myocardial infarction, stroke, and peripheral vascular disease, appear from middle age, the process of atherosclerosis can begin early in childhood. The early stage and progression of atherosclerosis in youth are influenced by risk factors that include obesity, hypertension, dyslipidemia, and smoking, and by the presence of specific diseases, such as diabetes mellitus and Kawasaki disease (KD). The existing evidence indicates that primary prevention of atherosclerotic disease should begin in childhood. Identification of children at risk for atherosclerosis may allow early intervention to decrease the atherosclerotic process, thereby preventing or delaying CVD. This review will describe the origin and progression of atherosclerosis in childhood, and the identification and management of known risk factors for atherosclerotic CVD in children and young adults.


Atherosclerosis; Cardiovascular diseases; Child; Adolescent; Primary prevention

MeSH Terms

Cardiovascular Diseases
Diabetes Mellitus
Early Intervention (Education)
Middle Aged
Mucocutaneous Lymph Node Syndrome
Myocardial Infarction
Peripheral Vascular Diseases
Primary Prevention
Risk Factors
Young Adult


  • Fig. 1 Natural history of atherosclerosis.

  • Fig. 2 Estimated probability of advanced atherosclerotic lesions in the coronary arteries by PDAY risk scores. PDAY: Pathobiological Determinants of Atherosclerosis in Youth.

  • Fig. 3 Risk-stratification and treatment algorithm for high-risk pediatric populations. Detailed informations on the treatment recommendations are available at Ref.40)41) Step 4-for tier I, initial management is therapeutic lifestyle change plus disease-specific management, while for tiers II and III, initial management is therapeutic lifestyle change; Step 5-for tiers II and III, if goals are not met after initial management, consider medication. FH: familial hypercholesterolemia, ESRD: end-stage renal disease, CV: cardiovascular, CAD: coronary artery disease, BP: blood pressure, LDL: low-density lipoprotein, FG: fasting glucose, HgbA1c: hemoglobin A1C, ht: height, pt: patient.


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