Developmental mechanisms involved in the primary prevention of atherosclerosis and cardiovascular disease.

The common belief that signs of atherosclerosis and cardiovascular disease (CVD) are clinically relevant only during adult and elderly age is gradually changing. Increasing evidence supports the concept that CVD is initiated through developmental in utero processes beginning before birth. Epigenetic and other unknown mechanisms underlying these developmental events are yet to be elucidated. The clinical implications of such theories for the primary prevention of CVD are intuitive and logical, but clinical prospective studies and translational approaches are still warranted. The evolution of CVD is usually characterized by a long lag time between onset and clinical manifestation, thereby providing a relevant opportunity for its early non-invasive detection during childhood and tailored therapeutic strategies, both with established pharmacologic agents and newly developed drugs that can affect epigenetic mechanisms.