Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System, Mortality 2018-2023 on CDC WONDER Online Database, released in 2024. Data are from the Multiple Cause of Death Files, 2018-2023, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. wonder.cdc.gov (accessed 18 June 2025).
Ikomi, C. & Baker-Smith, C. M. Where a child lives matters: neighborhood deprivation and pediatric obesity. Curr. Opin. Pediatr. 36, 3–9 (2024).
Google Scholar
Barry, M. J. et al. Screening for lipid disorders in children and adolescents: US preventive services task force recommendation statement. JAMA 330, 253–260 (2023).
Google Scholar
Krist, A. H. et al. Screening for high blood pressure in children and adolescents: US preventive services task force recommendation statement. JAMA 324, 1878–1883 (2020).
Google Scholar
Nordestgaard, B. G. et al. Familial hypercholesterolaemia is underdiagnosed and undertreated in the general population: guidance for clinicians to prevent coronary heart disease: consensus statement of the European Atherosclerosis Society. Eur. Heart J. 34, 3478–3490a (2013).
Google Scholar
Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents; National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics 128, S213–S156 (2011).
Google Scholar
Third Report of the National Cholesterol Education Program (NCEP). Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation 106, 3143–3421 (2002).
Google Scholar
Gooding, H. C. et al. Application of pediatric and adult guidelines for treatment of lipid levels among US adolescents transitioning to young adulthood. JAMA Pediatr. 169, 569–574 (2015).
Google Scholar
Grundy, S. M. et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation 139, e1082–e1143 (2019).
Google Scholar
Berenson, G. S. et al. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N. Engl. J. Med. 338, 1650–1656 (1998).
Google Scholar
Koskinen, J. et al. Impact of lipid measurements in youth in addition to conventional clinic-based risk factors on predicting preclinical atherosclerosis in adulthood: international childhood cardiovascular cohort consortium. Circulation 137, 1246–1255 (2018).
Google Scholar
Jacobs, D. R. Jr. et al. Childhood cardiovascular risk factors and adult cardiovascular events. N. Engl. J. Med. 386, 1877–1888 (2022).
Google Scholar
Kartiosuo, N. et al. Cardiovascular risk factors in childhood and adulthood and cardiovascular disease in middle age. JAMA Netw. Open 7, e2418148 (2024).
Google Scholar
Meng, Y. et al. Blood pressure at different life stages over the early life course and intima-media thickness. JAMA Pediatr. 178, 133–141 (2024).
Google Scholar
Meng, Y. et al. Relative contribution of blood pressure in childhood, young- and mid-adulthood to large artery stiffness in mid-adulthood. J. Am. Heart Assoc. 11, e024394 (2022).
Google Scholar
Wiegman, A. et al. Efficacy and safety of statin therapy in children with familial hypercholesterolemia: a randomized controlled trial. JAMA 292, 331–337 (2004).
Google Scholar
Luirink, I. K. et al. 20-year follow-up of statins in children with familial hypercholesterolemia. N. Engl. J. Med. 381, 1547–1556 (2019).
Google Scholar
de Ferranti, S. D. et al. Cardiovascular risk reduction in high-risk pediatric patients: a scientific statement from the American Heart Association. Circulation 139, e603–e634 (2019).
Google Scholar
Hanssen, H. et al. Lifestyle interventions to change trajectories of obesity-related cardiovascular risk from childhood onset to manifestation in adulthood: a joint scientific statement of the Task Force for Childhood Health of the European Association of Preventive Cardiology and the European Childhood Obesity Group. Eur. J. Prev. Cardiol. 30, 1462–1472 (2023).
Google Scholar
Niinikoski, H. et al. Effect of repeated dietary counseling on serum lipoproteins from infancy to adulthood. Pediatrics 129, e704–e713 (2012).
Google Scholar
Hampl, S. E. et al. Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics 151, e2022060640 (2023).
Google Scholar
Obarzanek, E. et al. Long-term safety and efficacy of a cholesterol-lowering diet in children with elevated low-density lipoprotein cholesterol: seven-year results of the Dietary Intervention Study in Children (DISC). Pediatrics 107, 256–264 (2001).
Google Scholar
Dorgan, J. F. et al. Adolescent diet and metabolic syndrome in young women: results of the Dietary Intervention Study in Children (DISC) follow-up study. J. Clin. Endocrinol. Metab. 96, E1999–E2008 (2011).
Google Scholar
Niinikoski, H. et al. Blood pressure is lower in children and adolescents with a low-saturated-fat diet since infancy: the Special Turku Coronary Risk Factor Intervention Project. Hypertension 53, 918–924 (2009).
Google Scholar
Vos, M. B. et al. Added sugars and cardiovascular disease risk in children: a scientific statement from the American Heart Association. Circulation 135, e1017–e1034 (2017).
Google Scholar
Raitakari, O. T. et al. Effects of persistent physical activity and inactivity on coronary risk factors in children and young adults. The Cardiovascular Risk in Young Finns study. Am. J. Epidemiol. 140, 195–205 (1994).
Google Scholar
García-Hermoso, A., Ramírez-Vélez, R. & Saavedra, J. M. Exercise, health outcomes, and pædiatric obesity: a systematic review of meta-analyses. J. Sci. Med. Sport 22, 76–84 (2019).
Google Scholar
García-Hermoso, A., González-Ruiz, K., Triana-Reina, H. R., Olloquequi, J. & Ramírez-Vélez, R. Effects of exercise on carotid arterial wall thickness in obese pediatric populations: a meta-analysis of randomized controlled trials. Child Obes. 13, 138–145 (2017).
Google Scholar
Cataldo, R., John, J., Chandran, L., Pati, S. & Shroyer, A. L. Impact of physical activity intervention programs on self-efficacy in youths: a systematic review. ISRN Obes. 2013, 586497 (2013).
Google Scholar
National Center for Chronic Disease Prevention, Health Promotion (US) Office on Smoking and Health. Reports of the Surgeon General. The Health Consequences of Smoking — 50 Years of Progress: A Report of the Surgeon General (Centers for Disease Control and Prevention, 2014).
Khoury, M. et al. Reported electronic cigarette use among adolescents in the Niagara region of Ontario. CMAJ 188, 794–800 (2016).
Google Scholar
Friedman, A. S. & Xu, S. Associations of flavored e-cigarette uptake with subsequent smoking initiation and cessation. JAMA Netw. Open 3, e203826 (2020).
Google Scholar
Oosterhoff, M., Joore, M. & Ferreira, I. The effects of school-based lifestyle interventions on body mass index and blood pressure: a multivariate multilevel meta-analysis of randomized controlled trials. Obes. Rev. 17, 1131–1153 (2016).
Google Scholar
Perry, C. L. et al. School-based cardiovascular health promotion: the child and adolescent trial for cardiovascular health (CATCH). J. Sch. Health 60, 406–413 (1990).
Google Scholar
Eloranta, A. M. et al. Dietary factors associated with metabolic risk score in Finnish children aged 6-8 years: the PANIC study. Eur. J. Nutr. 53, 1431–1439 (2014).
Google Scholar
Santos-Beneit, G. et al. School-based cardiovascular health promotion in adolescents: a cluster randomized clinical trial. JAMA Cardiol. 8, 816–824 (2023).
Google Scholar
Resaland, G. K. et al. The effect of a two-year school-based daily physical activity intervention on a clustered CVD risk factor score — the Sogndal school-intervention study. Scand. J. Med. Sci. Sports 28, 1027–1035 (2018).
Google Scholar
Reed, K. E., Warburton, D. E., Macdonald, H. M., Naylor, P. J. & McKay, H. A. Action schools! BC: a school-based physical activity intervention designed to decrease cardiovascular disease risk factors in children. Prev. Med. 46, 525–531 (2008).
Google Scholar
Voerman, E. et al. Maternal body mass index, gestational weight gain, and the risk of overweight and obesity across childhood: an individual participant data meta-analysis. PLoS Med. 16, e1002744 (2019).
Google Scholar
Covington, L., Armstrong, B., Trude, A. C. B. & Black, M. M. Longitudinal associations among diet quality, physical activity and sleep onset consistency with body mass index z-score among toddlers in low-income families. Ann. Behav. Med. 55, 653–664 (2021).
Google Scholar
Potvin Kent, M., Pauzé, E., Roy, E. A., de Billy, N. & Czoli, C. Children and adolescents’ exposure to food and beverage marketing in social media apps. Pediatr. Obes. 14, e12508 (2019).
Google Scholar
Ramachandran, J. et al. Measures of neighborhood opportunity and adherence to recommended pediatric primary care. JAMA Netw. Open 6, e2330784 (2023).
Google Scholar
Ortiz-Whittingham, L. R. et al. Associations between neighborhood socioeconomic deprivation, IFNγ, and high-density lipoprotein particle size: data from the Washington, D.C. cardiovascular health and needs assessment. Psychoneuroendocrinology 157, 106346 (2023).
Google Scholar
Baker-Smith, C. M. et al. Association of area deprivation with primary hypertension diagnosis among youth medicaid recipients in Delaware. JAMA Netw. Open 6, e233012 (2023).
Google Scholar
Tong, J. et al. The impact of PM2. 5 on the growth curves of children’s obesity indexes: a prospective cohort study. Front. Public Health 10, 843622 (2022).
Google Scholar
Javed, Z. et al. Race, racism, and cardiovascular health: applying a social determinants of health framework to racial/ethnic disparities in cardiovascular disease. Circ. Cardiovasc. Qual. Outcomes 15, e007917 (2022).
Google Scholar
Fuchs, F. D. & Whelton, P. K. High blood pressure and cardiovascular disease. Hypertension 75, 285–292 (2020).
Google Scholar
Chen, X. & Wang, Y. Tracking of blood pressure from childhood to adulthood: a systematic review and meta-regression analysis. Circulation 117, 3171–3180 (2008).
Google Scholar
Khoury, M. & Urbina, E. M. Cardiac and vascular target organ damage in pediatric hypertension. Front. Pediatr. 6, 148 (2018).
Google Scholar
Flynn, J. T. et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 140, e20171904 (2017).
Google Scholar
Lurbe, E. et al. 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J. Hypertens. 34, 1887–1920 (2016).
Google Scholar
Song, P. et al. Global prevalence of hypertension in children: a systematic review and meta-analysis. JAMA Pediatr. 173, 1154–1163 (2019).
Google Scholar
Hansen, M. L., Gunn, P. W. & Kaelber, D. C. Underdiagnosis of hypertension in children and adolescents. JAMA 298, 874–879 (2007).
Google Scholar
Chiolero, A., Cachat, F., Burnier, M., Paccaud, F. & Bovet, P. Prevalence of hypertension in schoolchildren based on repeated measurements and association with overweight. J. Hypertens. 25, 2209–2217 (2007).
Google Scholar
Kaelber, D. C. et al. Diagnosis and medication treatment of pediatric hypertension: a retrospective cohort study. Pediatrics 138, e20162195 (2016).
Google Scholar
McEvoy, J. W. et al. 2024 ESC guidelines for the management of elevated blood pressure and hypertension. Eur. Heart J. 45, 3912–4018 (2024).
Google Scholar
Flynn, J. T. et al. Ambulatory blood pressure monitoring in children and adolescents: 2022 update: a scientific statement from the American Heart Association. Hypertension 79, e114–e124 (2022).
Google Scholar
Urbina, E. M. et al. Relation of blood pressure in childhood to self-reported hypertension in adulthood. Hypertension 73, 1224–1230 (2019).
Google Scholar
Tracy, R. E. et al. Histologic features of atherosclerosis and hypertension from autopsies of young individuals in a defined geographic population: the Bogalusa Heart Study. Atherosclerosis 116, 163–179 (1995).
Google Scholar
Homma, S. et al. Histopathological modifications of early atherosclerotic lesions by risk factors — findings in PDAY subjects. Atherosclerosis 156, 389–399 (2001).
Google Scholar
Juhola, J. et al. Combined effects of child and adult elevated blood pressure on subclinical atherosclerosis: the International Childhood Cardiovascular Cohort Consortium. Circulation 128, 217–224 (2013).
Google Scholar
Ayer, J. G. et al. HDL-cholesterol, blood pressure, and asymmetric dimethylarginine are significantly associated with arterial wall thickness in children. Arterioscler. Thromb. Vasc. Biol. 29, 943–949 (2009).
Google Scholar
Khoury, M., Khoury, P. R., Dolan, L. M., Kimball, T. R. & Urbina, E. M. Clinical implications of the revised AAP pediatric hypertension guidelines. Pediatrics 142, e20180245 (2018).
Google Scholar
Lurbe, E. et al. Blood pressure and obesity exert independent influences on pulse wave velocity in youth. Hypertension 60, 550–555 (2012).
Google Scholar
Aatola, H. et al. Influence of child and adult elevated blood pressure on adult arterial stiffness: the Cardiovascular Risk in Young Finns study. Hypertension 70, 531–536 (2017).
Google Scholar
Aggoun, Y. et al. Impaired endothelial and smooth muscle functions and arterial stiffness appear before puberty in obese children and are associated with elevated ambulatory blood pressure. Eur. Heart J. 29, 792–799 (2008).
Google Scholar
Sorof, J. M., Alexandrov, A. V., Cardwell, G. & Portman, R. J. Carotid artery intimal-medial thickness and left ventricular hypertrophy in children with elevated blood pressure. Pediatrics 111, 61–66 (2003).
Google Scholar
Urbina, E. M. et al. Relationship between elevated arterial stiffness and increased left ventricular mass in adolescents and young adults. J. Pediatr. 158, 715–721 (2011).
Google Scholar
Hanevold, C. et al. The effects of obesity, gender, and ethnic group on left ventricular hypertrophy and geometry in hypertensive children: a collaborative study of the International Pediatric Hypertension Association. Pediatrics 113, 328–333 (2004).
Google Scholar
Chung, J. et al. Risk of target organ damage in children with primary ambulatory hypertension: a systematic review and meta-analysis. Hypertension 80, 1183–1196 (2023).
Google Scholar
Li, X. et al. Childhood adiposity as a predictor of cardiac mass in adulthood: the Bogalusa heart study. Circulation 110, 3488–3492 (2004).
Google Scholar
Tran, A. H. et al. Subclinical systolic and diastolic dysfunction is evident in youth with elevated blood pressure. Hypertension 75, 1551–1556 (2020).
Google Scholar
Daniels, S. R., Loggie, J. M., Khoury, P. & Kimball, T. R. Left ventricular geometry and severe left ventricular hypertrophy in children and adolescents with essential hypertension. Circulation 97, 1907–1911 (1998).
Google Scholar
Verdecchia, P. et al. Left ventricular mass and cardiovascular morbidity in essential hypertension: the MAVI study. J. Am. Coll. Cardiol. 38, 1829–1835 (2001).
Google Scholar
Urbina, E. M. et al. Association of blood pressure level with left ventricular mass in adolescents. Hypertension 74, 590–596 (2019).
Google Scholar
Cheung, C. Y.-L., Ikram, M. K., Sabanayagam, C. & Wong, T. Y. Retinal microvasculature as a model to study the manifestations of hypertension. Hypertension 60, 1094–1103 (2012).
Google Scholar
Hauser, C. et al. Bivariate relation of vascular health and blood pressure progression during childhood. Atherosclerosis 381, 117215 (2023).
Google Scholar
Yan, Y. et al. International Childhood Cardiovascular Cohort Consortium I. Life-course cumulative burden of body mass index and blood pressure on progression of left ventricular mass and geometry in midlife: the Bogalusa Heart Study. Circ. Res. 126, 633–643 (2020).
Google Scholar
Yang, L., Magnussen, C. G., Yang, L., Bovet, P. & Xi, B. Elevated blood pressure in childhood or adolescence and cardiovascular outcomes in adulthood: a systematic review. Hypertension 75, 948–955 (2020).
Google Scholar
Hansen, H. S., Froberg, K., Hyldebrandt, N. & Nielsen, J. R. A controlled study of eight months of physical training and reduction of blood pressure in children: the Odense Schoolchild study. BMJ 303, 682–685 (1991).
Google Scholar
Cai, L. et al. Effect of childhood obesity prevention programs on blood pressure. Circulation 129, 1832–1839 (2014).
Google Scholar
Wells, T. G. et al. Safety, efficacy, and pharmacokinetics of telmisartan in pediatric patients with hypertension. Clin. Pediatr. 49, 938–946 (2010).
Google Scholar
Flynn, J. T. et al. Efficacy and safety of the angiotensin receptor blocker valsartan in children with hypertension aged 1 to 5 years. Hypertension 52, 222–228 (2018).
Google Scholar
Schaefer, F. et al. Efficacy and safety of valsartan compared to enalapril in hypertensive children: a 12-week, randomized, double-blind, parallel-group study. J. Hypertens. 29, 2484–2490 (2011).
Google Scholar
Seeman, T. et al. Regression of left-ventricular hypertrophy in children and adolescents with hypertension during ramipril monotherapy. Am. J. Hypertens. 20, 990–996 (2007).
Google Scholar
Kupferman, J. C. et al. Improvement of left ventricular mass with antihypertensive therapy in children with hypertension. Pediatr. Nephrol. 25, 1513–1518 (2010).
Google Scholar
Devereux, R. B. et al. Prognostic significance of left ventricular mass change during treatment of hypertension. JAMA 292, 2350–2356 (2004).
Google Scholar
Soliman, E. Z. et al. Effect of intensive blood pressure lowering on left ventricular hypertrophy in patients with hypertension: the Systolic Blood Pressure Intervention (SPRINT) trial. Circulation 135, 440–450 (2017).
Google Scholar
Verdecchia, P. et al. Usual versus tight control of systolic blood pressure in non-diabetic patients with hypertension (Cardio-Sis): an open-label randomised trial. Lancet 374, 525–533 (2009).
Google Scholar
Lonn, E. et al. Effects of ramipril on left ventricular mass and function in cardiovascular patients with controlled blood pressure and with preserved left ventricular ejection fraction: a substudy of the Heart Outcomes Prevention Evaluation (HOPE) trial. J. Am. Coll. Cardiol. 43, 2200–2206 (2004).
Google Scholar
Jiang, X., Srinivasan, S. R., Webber, L. S., Wattigney, W. A. & Berenson, G. S. Association of fasting insulin level with serum lipid and lipoprotein levels in children, adolescents, and young adults: the Bogalusa Heart Study. Arch. Intern. Med. 155, 190–196 (1995).
Google Scholar
McGill, H. C. Jr. et al. Associations of coronary heart disease risk factors with the intermediate lesion of atherosclerosis in youth. The Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. Arterioscler. Thromb. Vasc. Biol. 20, 1998–2004 (2000).
Google Scholar
Juonala, M. et al. Associations of dyslipidemias from childhood to adulthood with carotid intima-media thickness, elasticity, and brachial flow-mediated dilatation in adulthood: the cardiovascular risk in young Finns study. Arterioscler. Thromb. Vasc. Biol. 28, 1012–1017 (2008).
Google Scholar
Frontini, M. G. et al. Usefulness of childhood non-high density lipoprotein cholesterol levels versus other lipoprotein measures in predicting adult subclinical atherosclerosis: the Bogalusa Heart Study. Pediatrics 121, 924–929 (2008).
Google Scholar
Bays, H. E. et al. Obesity, dyslipidemia, and cardiovascular disease: a joint expert review from the Obesity Medicine Association and the National Lipid Association 2024. J. Clin. Lipidol. 18, e320–e350 (2024).
Google Scholar
Knuiman, J. T., West, C. E., Katan, M. B. & Hautvast, J. G. Total cholesterol and high density lipoprotein cholesterol levels in populations differing in fat and carbohydrate intake. Arteriosclerosis 7, 612–619 (1987).
Google Scholar
Perak, A. M. et al. Trends in levels of lipids and apolipoprotein B in US youths aged 6 to 19 years, 1999-2016. JAMA 321, 1895–1905 (2019).
Google Scholar
Riaño-Galán, I. et al. Proatherogenic lipid profile in early childhood: association with weight status at 4 years and parental obesity. J. Pediatr. 187, 153–157 (2017).
Google Scholar
Dai, S. et al. Non-high-density lipoprotein cholesterol: distribution and prevalence of high serum levels in children and adolescents: United States National Health and Nutrition Examination Surveys, 2005-2010. J. Pediatr. 164, 47–253 (2014).
Google Scholar
Magnussen, C. G. et al. Factors affecting the stability of blood lipid and lipoprotein levels from youth to adulthood: evidence from the Childhood Determinants of Adult Health study. Arch. Pediatr. Adolesc. Med. 165, 68–76 (2011).
Google Scholar
Stanesby, O. et al. Tracking of serum lipid levels from childhood to adulthood: systematic review and meta-analysis. Atherosclerosis 391, 117482 (2024).
Google Scholar
Gidding, S. S. et al. The agenda for familial hypercholesterolemia: a scientific statement from the American Heart Association. Circulation 132, 2167–2192 (2015).
Google Scholar
de Ferranti, S. D. et al. Prevalence of familial hypercholesterolemia in the 1999 to 2012 United States National Health and Nutrition Examination Surveys (NHANES). Circulation 33, 1067–1072 (2016).
Google Scholar
Moorjani, S. et al. Homozygous familial hypercholesterolemia among French Canadians in Quebec province. Arteriosclerosis 9, 211–216 (1989).
Google Scholar
Kwiterovich, P. O. Jr. Recognition and management of dyslipidemia in children and adolescents. J. Clin. Endocrinol. Metab. 93, 4200–4209 (2008).
Google Scholar
National Heart, Lung, and Blood Institute. Integrated guidelines for cardiovascular health and risk reduction in children and adolescents: full report. nhlbi.nih.gov (2011).
Ruel, I. et al. Simplified Canadian definition for familial hypercholesterolemia. Can. J. Cardiol. 34, 1210–1214 (2018).
Google Scholar
Buscot, M. J. et al. The combined effect of common genetic risk variants on circulating lipoproteins is evident in childhood: a longitudinal analysis of the cardiovascular risk in Young Finns Study. PLoS ONE 11, e0146081 (2016).
Google Scholar
Stone, N. J., Levy, R. I., Fredrickson, D. S. & Verter, J. Coronary artery disease in 116 kindred with familial type II hyperlipoproteinemia. Circulation 49, 476–488 (1974).
Google Scholar
Wiegman, A. et al. Familial hypercholesterolaemia in children and adolescents: gaining decades of life by optimizing detection and treatment. Eur. Heart J. 36, 2425–2437 (2015).
Google Scholar
Khoury, M. et al. Pediatric lipid screening and treatment in Canada: practices, attitudes, and barriers. Can. J. Cardiol. 36, 1545–1549 (2020).
Google Scholar
Zhang, Y. et al. Familial hypercholesterolemia variant and cardiovascular risk in individuals with elevated cholesterol. JAMA Cardiol. 9, 263–271 (2024).
Google Scholar
Defesche, J. C. et al. Familial hypercholesterolaemia. Nat. Rev. Dis. Prim. 3, 17093 (2017).
Google Scholar
Khoury, M. et al. The detection, evaluation, and management of dyslipidemia in children and adolescents: a Canadian Cardiovascular Society/Canadian Pediatric Cardiology Association clinical practice update. Can. J. Cardiol. 38, 1168–1179 (2022).
Google Scholar
Wald, D. S. & Bestwick, J. P. Reaching detection targets in familial hypercholesterolaemia: comparison of identification strategies. Atherosclerosis 293, 57–61 (2020).
Google Scholar
Wald, D. S. et al. Child-parent familial hypercholesterolemia screening in primary care. N. Engl. J. Med. 375, 1628–1637 (2016).
Google Scholar
Stein, E. A. et al. Efficacy and safety of lovastatin in adolescent males with heterozygous familial hypercholesterolemia: a randomized controlled trial. JAMA 281, 137–144 (1999).
Google Scholar
de Jongh, S. et al. Efficacy and safety of statin therapy in children with familial hypercholesterolemia: a randomized, double-blind, placebo-controlled trial with simvastatin. Circulation 106, 2231–2237 (2002).
Google Scholar
McCrindle, B. W., Ose, L. & Marais, A. D. Efficacy and safety of atorvastatin in children and adolescents with familial hypercholesterolemia or severe hyperlipidemia: a multicenter, randomized, placebo-controlled trial. J. Pediatr. 143, 74–80 (2003).
Google Scholar
Rodenburg, J. et al. Statin treatment in children with familial hypercholesterolemia: the younger, the better. Circulation 116, 664–668 (2007).
Google Scholar
de Jongh, S. et al. Early statin therapy restores endothelial function in children with familial hypercholesterolemia. J. Am. Coll. Cardiol. 40, 2117–2121 (2002).
Google Scholar
Braamskamp, M. et al. Effect of rosuvastatin on carotid intima-media thickness in children with heterozygous familial hypercholesterolemia: the CHARON study (hypercholesterolemia in children and adolescents taking rosuvastatin open label). Circulation 136, 359–366 (2017).
Google Scholar
Vuorio, A. et al. Statins for children with familial hypercholesterolemia. Cochrane Database Syst. Rev. 2019, CD006401 (2019).
Google Scholar
Khoury, M. & McCrindle, B. W. The rationale, indications, safety, and use of statins in the pediatric population. Can. J. Cardiol. 36, 1372–1383 (2020).
Google Scholar
Wu, F. et al. Childhood non-HDL cholesterol and LDL cholesterol and adult atherosclerotic cardiovascular events. Circulation 149, 217–226 (2024).
Google Scholar
Reyes-Soffer, G. et al. Lipoprotein(a): a genetically determined, causal, and prevalent risk factor for atherosclerotic cardiovascular disease: a scientific statement from the American Heart Association. Arterioscler. Thromb. Vasc. Biol. 42, e48–e60 (2022).
Google Scholar
Wilson, D. P., Koschinsky, M. L. & Moriarty, P. M. Expert position statements: comparison of recommendations for the care of adults and youth with elevated lipoprotein(a). Curr. Opin. Endocrinol. Diabetes Obes. 28, 159–173 (2021).
Google Scholar
O’Donoghue, M. L. et al. Lipoprotein(a), PCSK9 inhibition, and cardiovascular risk. Circulation 139, 1483–1492 (2019).
Google Scholar
Raitakari, O. et al. Lipoprotein(a) in youth and prediction of major cardiovascular outcomes in adulthood. Circulation 147, 23–31 (2023).
Google Scholar
Alonso, R. et al. Lipoprotein(a) levels in familial hypercholesterolemia: an important predictor of cardiovascular disease independent of the type of LDL receptor mutation. J. Am. Coll. Cardiol. 63, 1982–1989 (2014).
Google Scholar
Skinner, A. C., Ravanbakht, S. N., Skelton, J. A., Perrin, E. M. & Armstrong, S. C. Prevalence of obesity and severe obesity in US children, 1999–2016. Pediatrics 141, e20173459 (2018).
Google Scholar
Ndumele, C. E. et al. Cardiovascular-kidney-metabolic health: a presidential advisory from the American Heart Association. Circulation 148, 1606–1635 (2023).
Google Scholar
Janssen, I. et al. Comparison of overweight and obesity prevalence in school-aged youth from 34 countries and their relationships with physical activity and dietary patterns. Obes. Rev. 6, 123–132 (2005).
Google Scholar
Afshin, A. et al. Health effects of overweight and obesity in 195 countries over 25 years. N. Engl. J. Med. 377, 13–27 (2017).
Google Scholar
Freedman, D. S., Mei, Z., Srinivasan, S. R., Berenson, G. S. & Dietz, W. H. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. J. Pediatr. 150, 12–17.e2 (2007).
Google Scholar
Nielsen, J., Hulman, A., Narayan, K. M. V. & Cunningham, S. A. Body mass index trajectories from childhood to adulthood and age at onset of overweight and obesity: the influence of parents’ weight status. Am. J. Epidemiol. 191, 1877–1885 (2022).
Google Scholar
Buscot, M. J. et al. Distinct child-to-adult body mass index trajectories are associated with different levels of adult cardiometabolic risk. Eur. Heart J. 39, 2263–2270 (2018).
Google Scholar
Buscot, M. J. et al. Longitudinal association of a body mass index (BMI) genetic risk score with growth and BMI changes across the life course: the Cardiovascular Risk in Young Finns study. Int. J. Obes. 44, 1733–1742 (2020).
Google Scholar
Powell-Wiley, T. M. et al. Obesity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation 143, e984–e1010 (2021).
Google Scholar
Zieske, A. W., Malcom, G. T. & Strong, J. P. Natural history and risk factors of atherosclerosis in children and youth: the PDAY study. Pediatr. Pathol. Mol. Med. 21, 213–237 (2002).
Google Scholar
Sinaiko, A. R., Donahue, R. P., Jacobs, D. R. Jr. & Prineas, R. J. Relation of weight and rate of increase in weight during childhood and adolescence to body size, blood pressure, fasting insulin, and lipids in young adults. The Minneapolis Children’s Blood Pressure study. Circulation 99, 1471–1476 (1999).
Google Scholar
Sun, J. et al. Weight change from childhood to adulthood and cardiovascular risk factors and outcomes in adulthood: a systematic review of the literature. Obes. Rev. 22, e13138 (2021).
Google Scholar
Genovesi, S. et al. Association between lifestyle modifications and improvement of early cardiac damage in children and adolescents with excess weight and/or high blood pressure. Pediatr. Nephrol. 38, 4069–4082 (2023).
Google Scholar
Epstein, L. H., Kuller, L. H., Wing, R. R., Valoski, A. & McCurley, J. The effect of weight control on lipid changes in obese children. Am. J. Dis. Child. 143, 454–457 (1989).
Google Scholar
Ippisch, H. M. et al. Reversibility of cardiac abnormalities in morbidly obese adolescents. J. Am. Coll. Cardiol. 51, 1342–1348 (2008).
Google Scholar
Bruyndonckx, L. et al. Diet, exercise, and endothelial function in obese adolescents. Pediatrics 135, e653–e661 (2015).
Google Scholar
Lincoff, A. M. et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. N. Engl. J. Med. 389, 2221–2232 (2023).
Google Scholar
Weghuber, D. et al. Once-weekly semaglutide in adolescents with obesity. N. Engl. J. Med. 387, 2245–2257 (2022).
Google Scholar
Hayba, N., Rissel, C. & Allman Farinelli, M. Effectiveness of lifestyle interventions in preventing harmful weight gain among adolescents: a systematic review of systematic reviews. Obes. Rev. 22, e13109 (2021).
Google Scholar
Raitakari, O., Pahkala, K. & Magnussen, C. G. Prevention of atherosclerosis from childhood. Nat. Rev. Cardiol. 19, 543–554 (2022).
Google Scholar
Grundy, S. M. et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement. Circulation 112, 2735–2752 (2005).
Google Scholar
Morrison, J. A., Friedman, L. A. & Gray-McGuire, C. Metabolic syndrome in childhood predicts adult cardiovascular disease 25 years later: the Princeton Lipid Research Clinics Follow-up study. Pediatrics 120, 340–345 (2007).
Google Scholar
Khoury, M. et al. Role of waist measures in characterizing the lipid and blood pressure assessment of adolescents classified by body mass index. Arch. Pediatr. Adolesc. Med. 166, 719–724 (2012).
Google Scholar
Khoury, M., Manlhiot, C. & McCrindle, B. W. Role of the waist/height ratio in the cardiometabolic risk assessment of children classified by body mass index. J. Am. Coll. Cardiol. 62, 742–751 (2013).
Google Scholar
Haley, J. et al. A clinical tool to relate youth risk factors to adult cardiovascular events and type 2 diabetes: the International Childhood Cardiovascular Cohort Consortium. J. Pediatr. 276, 114277 (2025).
Google Scholar
Campbell, M. D. et al. Impact of ideal cardiovascular health in childhood on the retinal microvasculature in midadulthood: Cardiovascular Risk in Young Finns study. J. Am. Heart Assoc. 7, e009487 (2018).
Google Scholar
Divers, J. et al. Trends in incidence of type 1 and type 2 diabetes among youths — selected counties and Indian reservations, United States, 2002-2015. MMWR Morbidity Mortal. Wkly. Rep. 69, 161–165 (2020).
Google Scholar
de Ferranti, S. D. et al. Type 1 diabetes mellitus and cardiovascular disease: a scientific statement from the American Heart Association and American Diabetes Association. Diabetes Care. 37, 2843–2863 (2014).
Google Scholar
Nathan, D. M. et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N. Engl. J. Med. 353, 2643–2653 (2005).
Google Scholar
Bjornstad, P., Cherney, D. & Maahs, D. M. Early diabetic nephropathy in type 1 diabetes: new insights. Curr. Opin. Endocrinol. Diabetes Obes. 21, 279–286 (2014).
Google Scholar
Guy, J. et al. Lipid and lipoprotein profiles in youth with and without type 1 diabetes: the SEARCH for diabetes in youth case-control study. Diabetes Care. 32, 416–420 (2009).
Google Scholar
Panagiotopoulos, C., Hadjiyannakis, S., Henderson, M. & Diabetes Canada Clinical Practice Guidelines Expert Committee. Type 2 diabetes in children and adolescents. Can. J. Diabetes 42 (Suppl. 1), S247–S254 (2018).
Google Scholar
Meigs, J. B., Cupples, L. A. & Wilson, P. W. Parental transmission of type 2 diabetes: the Framingham Offspring study. Diabetes 49, 2201–2207 (2000).
Google Scholar
Harris, S. B., Bhattacharyya, O., Dyck, R., Hayward, M. N., Toth, E. L. & Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Type 2 diabetes in Aboriginal peoples. Can. J. Diabetes 37 (Suppl. 1), S191–S196 (2013).
Google Scholar
Shah, A. S. et al. ISPAD clinical practice consensus guidelines 2022: type 2 diabetes in children and adolescents. Pediatr. Diabetes 23, 872–902 (2002).
Google Scholar
Sellers, E. A., Yung, G. & Dean, H. J. Dyslipidemia and other cardiovascular risk factors in a Canadian First Nation pediatric population with type 2 diabetes mellitus. Pediatr. Diabetes 8, 384–390 (2007).
Google Scholar
Halpern, A. et al. Metabolic syndrome, dyslipidemia, hypertension and type 2 diabetes in youth: from diagnosis to treatment. Diabetol. Metab. Syndr. 2, 55 (2010).
Google Scholar
Einarson, T. R., Acs, A., Ludwig, C. & Panton, U. H. Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007-2017. Cardiovasc. Diabetol. 17, 83 (2018).
Google Scholar
Selvin, E. et al. Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann. Intern. Med. 141, 421–431 (2004).
Google Scholar
Hanssen, H. Vascular biomarkers in the prevention of childhood cardiovascular risk: from concept to clinical implementation. Front. Cardiovasc. Med. 9, 935810 (2022).
Google Scholar
Christian, S., Ridsdale, R., Lin, M. & Khoury, M. Evaluating the prevalence of lipid assessments in children in Alberta, Canada. CMAJ Open 11, E820–E825 (2023).
Google Scholar
Perak, A. M. et al. Toward a roadmap for best practices in pediatric preventive cardiology: a science advisory from the American Heart Association. Circ. Cardiovasc. Qual. Outcomes 16, e000120 (2023).
Google Scholar
Agency for Healthcare Research and Quality. Hospital Inpatient and Outpatient Use, Cost, and Quality. ahrq.gov (2025).
Carroll, M. D., Kit, B. K., Lacher, D. A., Shero, S. T. & Mussolino, M. E. Trends in lipids and lipoproteins in US adults, 1988-2010. JAMA 308, 1545–1554 (2012).
Google Scholar
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