ABSTRACT
The evidence that the atherosclerotic process begins in childhood is largely provided by autopsy studies. A study in 1955 found a 77% incidence of coronary artery disease among young U.S. soldiers killed in the Korean war (5). Similar evidence was provided by a 1971 investigation that found a 45% incidence of coronary artery disease in young soldiers killed in the Vietnam war (6). Multiple studies examining the coronary arteries of deceased subjects have found that coronary fatty streaks are rare in the first decade of life but common by age 20. Fibrous plaque formation is noted to occur in the second decade, with an increase in both extent and frequency during the third and fourth decades (7,8). The development and extent of atherosclerotic lesions in the aortas of young people has also been evaluated. A study of more than 500 subjects found fatty streaks in all individuals over 3 years of age (9). The extent of intimal surface involved progressed dramatically in the second decade of life. Fibrous plaques were seen by late adolescence; by 30 years of age, 90% of aortas contained fibrous plaques to some degree. Taken as a whole, these studies demonstrate that atherosclerosis is unquestionably a pediatric problem in that aortic fatty streaks develop extensively in childhood, coronary fatty streaks begin to form in adolescence, and fibrous plaques begin to develop in the teenage years.
