The early natural history of atherosclerosis and hypertension in the young: National Institutes of Health perspectives.

Atherosclerotic cardiovascular disease begins decades before its clinical manifestations first appear. Early detection may offer the best chance for prevention. The National Heart, Lung, and Blood Institute has sponsored several population studies that have described the development of cardiovascular disease risk factors and their relationship to the emergence of early atherosclerotic lesions. Clinical trials are underway testing interventions to lower risk factors in the young. Guidelines for clinicians have been promulgated. Advances in molecular biology and noninvasive imaging techniques will provide new opportunities to explore the interaction of genetic and environmental factors in the initiation of cardiovascular disease. In the future, individuals at high risk for progression of atherosclerosis may be identified earlier, when prevention will be more successful.