Abstract
Cardiovascular and cerebrovascular diseases (CVDs), primarily driven by atherosclerosis, remain the leading cause of mortality worldwide and represent a major healthcare burden. Mounting evidence demonstrates that atherosclerotic processes begin in childhood, with lipid streaks detectable as early as the first decade of life. The increasing prevalence of obesity, hypertension, dyslipidemia, insulin resistance, and other modifiable cardiovascular risk factors (CVRFs) in children and adolescents highlights the urgent need for prevention strategies starting early in life. This document, jointly produced by the Italian Society of Pediatrics (SIP), the Italian Society of Hypertension (SIIA), the Italian Society for the Study of Atherosclerosis (SISA), and the Italian Society for Cardiovascular Prevention (SIPREC), emphasizes that atherosclerosis should be considered a disease with its roots in childhood and that true primary prevention must begin from pregnancy and birth. Two possible and complementary levels of intervention should be considered: (1) population-wide promotion of healthy diets, lifestyles, and supportive environments; and (2) early identification and management of specific CVRFs in children and adolescents. The involvement of multiple stakeholders-families, pediatricians, schools, healthcare professionals, policymakers, patient associations, and the media-is crucial to ensure the effectiveness of prevention interventions. Particular attention must be given to obesity, as both an independent risk factor and a driver of additional metabolic and vascular risks. Fighting CVDs requires a paradigm shift: preventive action must start early, be comprehensive, and mobilize all sectors of society. Only by addressing cardiovascular risk during childhood can the future burden of CVDs be effectively reduced.