Pediatric aspects of lipid-induced atherogenesis

There is a need to protect our young from an atherogenic way of life. Atherosclerosis and its precursors have their onset in childhood. Correctable risk factors have been identified that have been shown to exert greater impact early in life than later. Optimal levels of these risk factors for children are being established. The rise in serum lipids, blood pressure, body fat, and blood sugar observed in transition from childhood to adult life is neither inevitable nor desirable. Cardiovascular disease in adults may well begin in childhood with medical trivia such as a tendency to obesity, moderate lipid aberrations, blood pressure elevation, lack of exercise, and the cigarette habit. Recent evidence continues to emphasize blood lipids in atherogenesis. A large amount of cholesterol in the high density lipid (HDL) fraction is protective while the cholesterol in the low density lipid (LDL) is atherogenic. Optimal total cholesterol/HDL cholesterol ratios are in the vicinity of 3.5, corresponding to half the adult average risk in the United States. Worldwide evidence suggests that adult cholesterol values of 180-200 mg/dl are associated with both a low coronary heart disease (CHD) mortality and favorable overall health. In order to achieve this, 140 mg/dl values are needed in children whose blood lipids tend to track into adult life. The rise in serum lipids and deterioration in the LDL/HDL ratio in transition from childhood to adult life seems preventable through hygienic means in childhood when faulty life-styles that promote lipid-induced atherogenesis are conditioned.