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THEROSCLEROSIS IS THOUGHTto begin in childhood and to develop silently for decades before clinical events such as myocardial infarction or stroke occur. Autopsy studies in children and adolescents have confirmed the presence of preclinical atherosclerotic lesions and shown their associations with antemortem vascular risk factors. [1][2][3] Studies using ultrasound imaging have demonstrated atherosclerotic wall thickening in the arteries of children with risk factors. [4][5][6] Longitudinal studies have shown that risk factor levels measured in childhood are predictive of risk factor levels in adulthood. [7][8][9] Moreover, levels of serum cholesterol measured in young adult men have been associated with cardiovascular disease in midlife. 10,11 Al-

Background-The American Heart Association (AHA) defined a new concept, cardiovascular health, and determined metrics needed to monitor it over time as part of its 2020 Impact Goal definition. Ideal cardiovascular health is defined by the presence of both ideal health behaviors and ideal health factors. The applicability of this concept to a cohort of children and its relationship with cardiometabolic outcomes in adulthood has not been reported. Methods and Results-The

. Objectives.  The Cardiovascular Risk in Young Finns Study is an on‐going multicentre study of atherosclerosis precursors in Finnish children and young adults. We have collected risk factor data in the 21‐year follow‐up performed in 2001. The aims of this analysis were to examine the levels, secular trends and east–west difference in risk factors amongst young adults. Design.  Population based follow‐up study. Subjects.  A total of 2283 participants aged 24–39 years in 2001 (63.5% of the original cohort). Main outcome measures.  Levels of serum lipids, apolipoproteins, blood pressure and smoking. Results.  The mean serum total cholesterol, low density lipoprotein cholesterol, high density lipoprotein (HDL) cholesterol and triglyceride concentrations in 24–39‐year‐old adults were 5.16, 3.27, 1.29 and 1.34 mmol L−1, respectively. Total cholesterol (5.21 vs. 5.12 mmol L−1, P = 0.046), HDL cholesterol (1.31 vs. 1.28 mmol L−1, P = 0.027), systolic blood pressure (118 vs. 115 mmHg, P < 0.0001) and diastolic blood pressure (72 vs. 70 mmHg, P < 0.0001) were higher in subjects originating from eastern Finland compared with those from western Finland. Significant secular trends between 1986 and 2001 in 24‐year‐old subjects (n = 783) included an increase in serum triglycerides and body mass index (BMI), a decrease in blood pressure and HDL cholesterol and a modest 5% decrease in total cholesterol levels. Conclusions.  During the past 15 years, BMI and triglyceride levels have increased in young adults in Finland. At the same time, the reduction in cholesterol concentration has been slow. Consistent with persistent regional differences in cardiovascular morbidity within Finland, our data demonstrate significant differences in the levels of cardiovascular risk factors between subjects originating from eastern and western Finland.

Reference values produced in the present study can be utilized in the cardiovascular risk stratification among young people. Sex differences in the markers of subclinical atherosclerosis were mostly explained by differences in risk factors and vessel size. This emphasizes the importance of risk factor control in the prevention of atherosclerosis in young adults.

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These findings indicate that children with risk factors have increased atherosclerosis progression rate in adulthood, and support the idea that the prevention of atherosclerosis by means of life style could be effective when initiated in childhood.