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Fall 2026

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Getting Ahead of Atherosclerotic Cardiovascular Disease: Prevention Early in the Life Course

Abbey N. Collins, PhD1; Morgann S. West, MA2; Melissa Adkins-Hempel, BA3; Lauren von Klinggraeff, PhD, MPH4 - Cardiovascular Disease SIG

While atherosclerotic cardiovascular disease (ASCVD) manifests primarily in adulthood, its risk factors associated with arteriosclerosis emerge early in life.1-4 Maintaining ideal cardiovascular health (CVH), defined as the presence of four favorable health behaviors (smoking, diet, physical activity, BMI) and three health factors (cholesterol, blood sugar, blood pressure), can mitigate CVD morbidity and mortality.5 Yet, CVH begins to decline during childhood. Among children and adolescents in the US, 3.53% and 9.42% have elevated blood pressure, respectively; 32.7% exhibit prediabetes, 21.1% are overweight or obese, and 4.8% have suboptimal low-density lipoprotein cholesterol.2,6 Unfavorable health behaviors also emerge during childhood, including insufficient physical activity, sleep duration, poor diet, and initiation of tobacco use.7,8 Accordingly, a life-course approach, which focuses on both preventing risk factors from developing (primordial prevention) and identifying and treating existing risk factors (primary prevention), is critical to reducing the burden of CVD in adulthood.9

These early patterns can persist into adulthood, highlighting childhood as an important period for preventing and treating CVD risk factors. This is important because maintaining CVH early in life is not only associated with better CV outcomes, but also with other benefits like a decreased likelihood of cancer, dementia, metabolic syndrome, reduced depression, better quality of life, and lower health care costs.1,10,11 Thus, it is necessary to identify and implement strategies to address risk factors in childhood not only to reduce ASCVD risk but to promote optimal health outcomes.  

Comprehensive prevention of ASCVD requires a multilevel approach that leverages input from multiple sources, including clinicians, parents, researchers, community members, and policymakers. Below, we propose targeted calls to action to better understand and monitor ASCVD risk early in the life course and to advocate for and promote a heart-healthy environment: 

Clinicians 

  1. Monitor and intervene on ASCVD risk factors during clinical care visits (e.g., pediatric Produce Prescription, track risk factors using electronic health record)12-14

  1. Involve children in conversations about heart-healthy habits by discussing the American Heart Association’s Life’s Essential 8 for Kids or the 5-2-1-0 healthy habits message15  

Researchers 

  1. Conduct longitudinal studies on CV health trajectories from conception through adulthood, measuring the impact of positive and negative life events, environmental exposures, genetics/epigenetics, and puberty16

  1. Identify and refine measures of CVD health and outcomes in childhood (e.g., biomarkers)16

  1. Examine how CVD risk and prevention strategies may vary by subpopulation and social determinants of health (e.g., health risk factors, race/ethnicity, sex, rural communities, low socioeconomic status, uninsured groups)16

Family and community members  

  1. Integrate heart-healthy habits at home (e.g., healthy food options, consistent sleep routine, nicotine-free home, frequent physical activity, be mindful of kids' mental health, limited screen time)16, 17

  1. Provide safe, accessible, and affordable access to health-promoting environments (e.g., summer camps, afterschool programs, community centers, churches)14

Policy 

  1. Advocate for policy changes at the local, state, and federal level for initiatives to improve heart-healthy habits early in the life course (e.g., healthier school lunches, 60 minutes of play, limited screen time to improve sleep, tobacco use)14, 16, 18, 19

  1. Integrate heart-healthy habits in schools (e.g., physical education, classroom activity breaks, restrictions on low-nutrient foods and sugar-sweetened beverages, and nicotine prevention programming)14, 16, 19, 20

Affiliations:

  1. North Carolina State University, Raleigh, North Carolina 

  1. Northwestern University Feinberg School of Medicine, Chicago, Illinois 

  1. Eastern Carolina University, Greenville, North Carolina 

  1. Augusta University, Augusta, Georgia  

References:

  1. Schipper HS, de Ferranti S. Atherosclerotic Cardiovascular Risk as an Emerging Priority in Pediatrics. Pediatrics. 2022;150(5):e2022057956. doi:10.1542/peds.2022-057956  

  1. Palaniappan LP, Allen NB, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Bansal N, Currie ME, Earlie RS, Fan W, Fetterman JL, Barone Gibbs B, Heard DG, Hiremath S, Hong H, Hyacinth HI, Ibeh C, Jiang T, Johansen MC, Kazi DS, Ko D, Kwan TW, Leppert MH, Li Y, Magnani JW, Martin KA, Martin SS, Michos ED, Mussolino ME, Ogungbe O, Parikh NI, Perez MV, Perman SM, Sarraju A, Shah NS, Springer MV, St-Onge M-P, Thacker EL, Tierney S, Urbut SM, Van Spall HGC, Voeks JH, Whelton SP, Wong SS, Zhao J, Khan SS; on behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Committee. 2026 Heart disease and stroke statistics: a report of US and global data from the American Heart Association. Circulation. Published online January 21, 2026 

  1. 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. 2011;128 Suppl 5(Suppl 5):S213-S256. doi:10.1542/peds.2009-2107C  

  1. Krefman AE, Labarthe D, Greenland P, et al. Influential Periods in Longitudinal Clinical Cardiovascular Health Scores. Am J Epidemiol. 2021;190(11):2384-2394. doi:10.1093/aje/kwab149 

  1. Lloyd-Jones DM, Allen NB, Anderson CAM, et al. Life's Essential 8: Updating and Enhancing the American Heart Association's Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association. Circulation. 2022;146(5):e18-e43. doi:10.1161/CIR.0000000000001078  

  1. Ouyang D, Cao W, Shen Y, Chen L, Hu G. Trends and risk factors of hypertension in US Children and Adolescents, 1999-2023. J Hum Hypertens. 2026;40(2):118-126. doi:10.1038/s41371-025-01102-9  

  1. Liu J, Rehm CD, Onopa J, Mozaffarian D. Trends in Diet Quality Among Youth in the United States, 1999-2016. JAMA. 2020;323(12):1161-1174. doi:10.1001/jama.2020.0878  

  1. Wheaton AG, Claussen AH. Short Sleep Duration Among Infants, Children, and Adolescents Aged 4 Months–17 Years — United States, 2016–2018. MMWR Morb Mortal Wkly Rep 2021;70:1315–1321. DOI: http://dx.doi.org/10.15585/mmwr.mm7038a1 

  1. Steinberger J, Daniels SR, Hagberg N, et al. Cardiovascular Health Promotion in Children: Challenges and Opportunities for 2020 and Beyond: A Scientific Statement From the American Heart Association. Circulation. 2016;134(12):e236-e255. doi:10.1161/CIR.0000000000000441  

  1. Aris IM, Rifas-Shiman SL, Perng W, et al. Trajectory of Cardiovascular Health Across Childhood and Adolescence. JAMA Cardiol. 2025;10(5):417-426. doi:10.1001/jamacardio.2024.4022 

  1. Perak AM, Benuck I. Preserving Optimal Cardiovascular Health in Children. Pediatr Ann. 2018;47(12):e479-e486. doi:10.3928/19382359-20181115-01 

  1. Gauen AM, Wang Y, Perak AM, et al. Adherence to Pediatric Screening. J Am Heart Assoc. 2024;13(21):e033589. doi:10.1161/JAHA.123.033589  

  1. Muleta H, Fischer LK, Chang M, et al. Pediatric produce prescription initiatives in the U.S.: a scoping review. Pediatr Res. 2024;95(5):1193-1206. doi:10.1038/s41390-023-02920-8  

  1. Lloyd-Jones DM, Ning H, Labarthe D, et al. Status of Cardiovascular Health in US Adults and Children Using the American Heart Association's New "Life's Essential 8" Metrics: Prevalence Estimates From the National Health and Nutrition Examination Survey (NHANES), 2013 Through 2018. Circulation. 2022;146(11):822-835. doi:10.1161/CIRCULATIONAHA.122.060911  

  1. Berg KA, Still CH, Ryan P. CVD risk factors among adolescents. Cardi-OH. Published June 27, 2024. Accessed August 26, 2026. https://www.cardi-oh.org/files/resources/cardi-oh-cvd-risk-factors-among-adolescents.pdf  

  1. Daniels SR, Pratt CA, Hollister EB, et al. Promoting Cardiovascular Health in Early Childhood and Transitions in Childhood through Adolescence: A Workshop Report. J Pediatr. 2019;209:240-251.e1. doi:10.1016/j.jpeds.2019.01.042  

  1. Merschel M. What parents can do to protect kids from heart disease. American Heart Association News. Published August 4, 2022. Accessed August 26, 2026. https://www.heart.org/en/news/2022/08/04/what-parents-can-do-to-protect-kids-from-heart-disease  

  1. American Heart Association. Students call out tobacco industry on Quit Lying Day. Published January 16, 2020. Accessed August 26, 2026. https://www.heart.org/en/around-the-aha/students-call-out-tobacco-industry-on-quit-lying-day 

  1. Ferdinand KC. Primordial Prevention of Cardiovascular Disease in Childhood: The Time Is Now. J Am Coll Cardiol. 2019;73(16):2022-2024. doi:10.1016/j.jacc.2019.02.024  

  1. Barron K. CVD prevention in children and implications for the school nurse. Preventive Cardiovascular Nurses Association. Published June 14, 2023. Accessed August 26, 2026. https://pcna.net/news/cvd-prevention-in-children-and-implications-for-the-school-nurse/