Khoury Michael, Ware Adam L, McCrindle Brian W
Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada.
Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA.
Nat Rev Cardiol. 2025 Sep 12. doi: 10.1038/s41569-025-01209-z.
Growing evidence from the past seven decades indicates that atherosclerosis begins in youth and progresses in response to exposure to cardiovascular risk factors, which contribute to the development of cardiovascular disease in later life. A long-term randomized clinical trial lasting at least 50 years and involving screening and follow-up of children across their lifespan would provide the highest level of evidence to determine the lifelong influence of cardiovascular risk factors on cardiovascular disease risk but such an approach is not feasible. However, much can be learned from observing patients with familial hypercholesterolaemia. Those patients who were treated at a young age remained event-free into adulthood, beyond the ages at which their affected parent, who initiated treatment at a much later age, experienced their first cardiovascular event. The evidence is less certain for other types of dyslipidaemia and other cardiovascular risk factors, including high blood pressure. Nonetheless, the strategy of waiting until later in adulthood to screen and intervene, often after a non-fatal cardiovascular disease event has already occurred, might no longer seem prudent. In this Review, we summarize the growing body of evidence supporting intensified efforts to identify cardiovascular risk factors in children and young adults, and to identify knowledge gaps among this cohort such as the optimal timing and strategy for blood lipid screening.
过去七十年来越来越多的证据表明，动脉粥样硬化始于年轻时，并随着接触心血管危险因素而进展，这些因素会导致晚年心血管疾病的发生。一项持续至少50年、涉及对儿童进行全生命周期筛查和随访的长期随机临床试验，将为确定心血管危险因素对心血管疾病风险的终身影响提供最高水平的证据，但这种方法并不可行。然而，通过观察家族性高胆固醇血症患者可以了解到很多信息。那些在年轻时接受治疗的患者在成年后仍无心血管事件发生，而他们受影响的父母在晚得多的年龄开始治疗，在这个年龄已经经历了首次心血管事件。对于其他类型的血脂异常和其他心血管危险因素（包括高血压），证据的确定性较低。尽管如此，等到成年后期才进行筛查和干预的策略，通常是在非致命性心血管疾病事件已经发生之后，可能不再显得审慎。在本综述中，我们总结了越来越多的证据，这些证据支持加大力度识别儿童和年轻人中的心血管危险因素，并识别该队列中的知识空白，如血脂筛查的最佳时机和策略。
