[Cardiovascular risk factors in children. Main findings of the Four Provinces study]

Atherosclerosis is a process that begins during the first few decades of life, progresses asymptomatically, and generally shows no clinical manifestations until adulthood. The Spanish Four Provinces study, which involved 1275 prepubertal children, was an investigation into childhood risk factors for atherosclerosis (e.g., diet, anthropometric variables, lipid levels, and some genetic factors) that may be related to the occurrence of coronary artery disease in adults. In this review, we summarize the study's most important findings. The Four Provinces study showed that several factors associated with the metabolic syndrome (i.e., obesity, and raised glucose and triglyceride levels), which can lead to coronary disease in adults, are already present in schoolchildren. What is more, children from provinces with high coronary disease mortality weighed more and had higher plasma triglyceride and glucose levels. A high percentage of children in all provinces studied had total cholesterol and low-density lipoprotein cholesterol plasma levels above the recommended values. Despite the presence of some positive features in the population as a whole, such as a raised high-density lipoprotein cholesterol level and low prevalence of the apolipoprotein-E epsilon4 allele, which is known to be related to cardiovascular risk, if the metabolic changes described above persist, the risk of cardiovascular disease in Spain can only increase in the future. These metabolic characteristics are associated with a high-fat, low-carbohydrate diet which is far from that currently recommended for children. Correction of this poor diet at an early age would have significant benefits for the prevention of cardiovascular disease.