The pediatric aspects of atherosclerosis

Atherosclerosis begins in childhood with the appearance of aortic fatty streaks. Aortic fatty streaks of some degree are present in practically all individuals from every human population that has been studied. The average amount of aortic intimai surface involved with fatty streaks does not differ much among human populations.

Coronary fatty streaks begin to form in adolescence. Most persons 20-29 years of age have coronary fatty streaks of some degree, even if they are from low socioeconomic strata.

While fatty streaking is clinically harmless and potentially reversible, the progression of fatty streaks to more advanced lesions is a critical stage of atherosclerosis. This conversion takes place at earlier ages in populations with high morbidity and mortality from coronary heart disease.

The development of fibrous plaques begins in the twenties. Therefore, even though control programs which attempt to reduce coronary heart disease by preventing atherosclerosis may meet some success when applied to middle-aged persons, these programs should be directed toward individuals in the twenties and thirties for maximum benefits. Dietary habits that retard atherosclerosis should be established in childhood.