Cardiovascular disease burden in children with obesity: A narrative review.

Childhood obesity is increasing alarmingly and cardiovascular disease (CVD), a major complication of obesity, is documented to begin early during childhood and has detectable, preventable stages. The current guidelines for mitigating CVD prevalence do not incorporate tests for diagnosis of subclinical atherosclerosis. A literature search under the key words “obesity, children, cardiovascular, subclinical atherosclerosis, vascular health, cardiometabolic” was conducted to cover the period from 2010-2025 in PubMed and the Cochrane Database of Systematic Reviews for articles published up to October 1, 2025, using combinations of terms such as “child”, “adolescent”, “obesity”, “epidemiology”, “etiology”, “complications”, “cardiovascular”, “treatment”, “atherosclerosis”, “prevention”, “endothelial function”, “pharmacotherapy”, and “BMI”. Data about the diagnosis, and management of obesity and its CVD complications were summarized in this paper. Atherosclerosis is documented to have detectable subclinical, potentially reversible stages during childhood. The current guidelines for risk stratification do not account for the cumulative vascular burden of obesity leaving early subclinical stages undetected. While tools such as carotid intima-media thickness and carotid-femoral pulse wave velocity show clear associations with obesity and cardiometabolic risk, there is still lack of consensus on their use in routine care. More research is needed to identify tools that can be incorporated into clinical guidelines for diagnosis of subclinical CVD in children with obesity. • The global prevalence of childhood obesity is increasing to alarming levels. • Cardiovascular complications of obesity start in childhood, have cumulative effect, often coexist with multiple risk factors and are potentially reversible. • There are available tools for detection of subclinical atherosclerosis in children including measurement of intima media thickness and carotid-femoral pulse wave velocity; however, more studies are needed to refine these techniques • The current guidelines for risk stratification fail to account for the subclinical stages and cumulative vascular burden of obesity. • Cardiovascular health promotion using innovative tools such as mobile digital devices is critically needed in youth.