Atherosclerosis of arterial vessels starts early in life, often in childhood. Subclinical atherosclerotic lesions can already be detected non-invasively in children presenting with cardiovascular risk factors. Impairment of endothelial function, pathologically altered intima-media thickness and increased arterial stiffness are evident long before cardiovascular events occur. Childhood obesity is a key player in the pathogenesis of cardiovascular disorders since obesity causes metabolic, immunological and haemodynamic alterations preceding disease onset. The effectiveness of secondary prevention programmes that include dietary restriction and exercise has been well demonstrated. Pharmacotherapy and bariatric surgery can be helpful in the extremely obese who have co-morbidities, but long-term risk and safety profile results are lacking. Evidence of primary prevention programmes to avoid risk factor accumulation and disease onset is not as strong. Nevertheless, the positive effects of dietary recommendations and exercise programmes on risk factors have been documented.
Beck EB, Walther C, Erbs, S, Körner A. European Cardiology 2009;5:34–9.