Protecting children from passive smoking.

Childhood is a time in which foundations are laid on which the adult is formed. Nevertheless, it is surprising for most to discover just how early in life arteries can show signs of structural or functional damage that may indicate vulnerability to atherosclerosis. Napoli et al1 were the first to demonstrate that even fetal aortas could develop fatty streaks in utero in the presence of maternal hyperlipidemia, and recently, Skilton et al2 have documented in vivo evidence of aortic wall thickening in at-risk newborns because of intrauterine growth restriction. Evidence of functional arterial abnormalities also has been documented in the first decade of life in high-risk children (eg, in those with familial hypercholesterolemia).3 Although such abnormalities do not usually lead to clinical consequences until middle adulthood, their genesis in childhood underscores the 2 key missions of atheroprevention: early detection of individuals and groups at risk and definition of strategies to prevent or reverse early atherogenic changes.