Atherosclerotic vascular changes can begin early in childhood, setting the stage for cardiovascular disease events in adulthood. However, in some children, the process is accelerated because of the presence of identifiable risk factors as obesity, dyslipidaemia, hypertension or specific diseases that are associated with premature cardiovascular disease.
The evidence linking atherosclerotic changes in childhood to later in life will be reviewed here. Pediatrics intrusion is to reduce or minimize atherosclerosis and management of the child at risk for atherosclerosis are discussed separately. Neonatalogy deterrence of cardiovascular disease: Promoting a healthy lifestyle and identifying at-risk children and an overview of the management of the child or adolescent at risk for atherosclerosis.
Evidence for the development of atherosclerosis in childhood includes autopsy studies showing atherosclerotic changes in the young and non-invasive, indirect data in children and adolescents showing vascular changes that commonly precede adult cardiovascular disease.
Atherosclerosis begins in childhood as an accumulation of fatty streaks-lipid-engorged macrophages (foam cells) and T lymphocytes in the intima of the arteries. In some people, lipid accumulation is more pronounced with time, and the accumulated lipid becomes covered by a fibromuscular cap to form what is termed a fibrous plaque. Temporally, between the fatty streak and the fibrous plaque, transitional stages of atherosclerosis exist that are not identifiable by gross examination alone. With time, fibrous plaques enlarge and undergo calcification, hemorrhage, ulceration or rupture, and thrombosis. Thrombotic occlusion precipitates clinical disease such as myocardial infarction, stroke, or gangrene depending on which artery is affected in pediatrics and neonates.