Optimizing Cardiovascular Health Across the Life Course.

The American Heart Association (AHA) has prompted considerable national and global emphasis on the promotion of ideal cardiovascular health (ICVH) across the life course. The AHA’s 2010 document 1 focused on the 2020 strategic impact goal of improving the cardiovascular health of all Americans by 20% while simultaneously reducing deaths from cardiovascular diseases (CVDs) and stroke by 20% has stimulated considerable research, practice, public education, and policyrelated initiatives focused on optimizing cardiovascular health across the life course. The majority of children are born with ICVH as defined and operationalized by the 7 AHA metrics that include 4 health behaviors (smoking status, body mass index [BMI], physical activity, healthy diet score) and 3 health factors (total cholesterol, blood pressure, fasting plasma glucose). Population-based prevalence data, however, indicate unacceptably high prevalence of adverse levels of these health factors and behaviors in childhood. A recent report from the National Health and Nutrition Examination Surveys provided prevalence data for several ICVH metrics (total cholesterol, BMI, blood pressure, diet) for children aged 2 to 11 years. Of note and consistent with other reports, ideal healthy diet score was least prevalent in children (0.1%), whereas ideal levels of blood pressure were most prevalent (90.5%). Approximately 40% of children exhibited intermediate (170Y199 mg/dL) or poor (>200 mg/dL) total cholesterol. Ideal BMI (<85th ageand sexspecific percentile) was less frequent in 6to 11-year-old children than in children 2 to 5 years of age (67% vs 77%, respectively). Underscoring the importance of the life course approach are 3 decades of clinical and epidemiological research that provides convincing evidence: atherosclerosis begins early in life and is influenced and accelerated over time by potentially modifiable adverse health factors and behaviors. In addition, data indicate that individuals who maintain optimal levels of established risk factors for CVD through adult life have dramatically lower lifetime CVD risk and markedly longer survival than their adult counterparts who developed 1 or more risk factors earlier in life. Primordial prevention, highlighted in the AHA’s strategic plan and subsequent publications, places emphasis on preventing the development of adverse health factors and behaviors and also considers macrolevel strategies such as environmental and policy initiatives that enable development and maintenance of behaviors central to ICVH. Exemplifying the benefits of primordial prevention is evidence generated from several pediatric cohort studies that point to the importance of modifiable factors that have potential to promote the maintenance of ICVHbeyond early life. Conducted in Finland, STRIP (Special Turku Coronary Risk Factor Intervention Project for Children) is a prospective, randomized trial designed to prevent atherosclerosis beginning in infancy. Families of 6-month-old infants were recruited from clinics in Turku, and infants were subsequently randomized to a dietary intervention (n = 540) or control (n = 522) group. The intervention group received individualized dietary and subsequently antismoking counseling at least biannually until 20 years of age. At follow-up, complete data on ICVH metrics were available at 15 (n = 394), 17 (n = 376), and 19 (n = 298) years of age. Adolescents in the control group had an increased risk of low ICVH (e3 metrics) compared with the intervention adolescents; the number of