Atherosclerosis Begins in Childhood: A Life-Course Perspective on Arterial Remodeling from the Bogalusa Heart Study

Abstract Purpose of Review This review summarizes carotid intima–media thickness (cIMT) findings from the Bogalusa Heart Study (BHS) and examines how cardiovascular risk factors across the life course contribute to early subclinical atherosclerosis. Recent Findings BHS studies consistently demonstrate that obesity, dyslipidemia, and SBP are independently associated with increased cIMT in young adulthood. Life-course analyses show that cumulative BMI and LDL-C exposure independently predict adult cIMT, with race-specific sensitive periods identified for obesity. Metabolically abnormal obesity confers greater vascular risk than metabolically healthy obesity. LDL-C and the total cholesterol/HDL-C ratio are the principal lipid determinants of carotid wall thickening, with associations strengthening from childhood through midlife. SBP dominates in cross-sectional models, while BMI shows more consistent independent effects beginning in childhood. Cardiometabolic clustering further amplifies vascular risk, and adolescence represents a key developmental window, with pediatric metabolic syndrome performing no better than BMI alone in predicting adult cIMT. Summary BHS evidence supports the view that atherosclerosis is a progressive disease that begins in childhood and develops through the cumulative burden of risk factors over the life-course. Obesity, dyslipidemia, and elevated blood pressure each independently contribute to cIMT, and their clustering within individuals amplifies this effect, such that the combined sustained burden across the life-course is the strongest determinant of subclinical arterial remodeling. This underscores the importance of early, sustained prevention strategies that target modifiable CV risk factors beginning in childhood.