Concept of Bridging the Gap From Youth to Adulthood

Clinical atherosclerotic cardiovascular disease reaches substantial incidence beginning at age 45 years in men and age 55 years in women but has its onset in childhood. Lesions progress in relation to exposure to identified risk factors and, once initiated, tend to be self-perpetuating. Because predisposing factors are often initiated in childhood, interventions beginning early in life are optimal for prevention of adult disease. Even genetically predisposed people usually require an unfavorable lifestyle for the atherogenic trait to be expressed. No combination of risk factors entirely accounts for the increase in clinical atherosclerotic events with advancing age. This may be a reflection of longer exposure to risk factors or impaired ability to cope with them in advanced age. The declining risk factor risk ratios with advancing age may be a consequence of the selective early removal of those most susceptible from the population at risk. Risk of major cardiovascular events increases about 2.5-fold with each 10 years of age, even in people without major risk factors who are considered at low risk for atherosclerotic cardiovascular events. However, at any age vulnerability to cardiovascular events is strongly influenced by the burden of risk factors. Decreased risk ratios with advanced age are offset by a greater absolute risk. The female advantage over men erodes with age, with the menopause and with acquisition of an unfavorable lipid profile and glucose intolerance.