The inheritance of cardiovascular disease risk.

Cardiovascular disease (CVD) is foremost among the non-communicable diseases (NCDs) which account for 71% of deaths globally each year. CVD is also prominent among the pre-existing conditions still accounting for nearly 25% of maternal deaths and is linked to gestational diabetes and pre-eclampsia. Markers of CVD risk have been reported even in young children, related to prenatal factors such as mother's diet or body composition. The underlying mechanisms include epigenetic changes which can alter the trajectory of risk across the life course. Preventive interventions need to commence before conception, to reduce transmission of CVD risk by promoting healthy behaviours in prospective parents, as well as in pregnancy, and postpartum through breastfeeding and healthy complementary feeding. Surprisingly, these opportunities are not emphasised in the 2018 United Nations Political Declaration on NCDs. NCDs such as CVD have communicable risk components transmitted across generations by socio-economic as well as biological factors, although the former can also become embodied in the offspring by epigenetic mechanisms. The inheritance of CVD risk, and social inequalities in such risk, thus raises wider questions about responsibility for the health of future generations at societal as well as individual levels. ©2019 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.