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. 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. 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.
This review summarizes key cardiovascular disease prevention studies presented at the 2026 European Society of Cardiology (ESC) Congress, highlighting new evidence in lipid management, cardiovascular risk assessment, blood pressure control, and vaccination. Several studies addressed persistent gaps in lipid management and atherosclerotic cardiovascular disease prevention. STAREE showed that atorvastatin reduced major cardiovascular events in adults aged 70 years and older without established cardiovascular disease, although it did not significantly improve disability-free survival. The SHASTA-3 and SHASTA-4 trials showed that plozasiran produced substantial and sustained triglyceride reductions and reduced acute pancreatitis events in patients with severe hypertriglyceridemia. VICTORION-Challenge demonstrated greater LDL-C reduction and target attainment with inclisiran compared with bempedoic acid in high- and very-high-risk patients receiving background statin therapy. In patients with homozygous familial hypercholesterolemia, VSA003 substantially lowered LDL-C and several other atherogenic lipoproteins by inhibiting ANGPTL3. Two studies examined imaging-based approaches to preventive therapy: RESPECT2 showed that coronary computed tomography angiography-guided lipid management improved adherence compared with conventional risk-score-based treatment, while CorCal found that coronary artery calcium-guided statin recommendations reduced the number of patients selected for treatment and were associated with greater LDL-C lowering and higher reported adherence, although noninferiority for cardiovascular events was not established. Beyond lipid management, long-term follow-up of the China Rural Hypertension Control Project showed that intensive blood pressure management led by non-physician healthcare providers reduced dementia and cognitive impairment. TIMER demonstrated sustained LDL-C lowering with once-monthly ticalicibart in patients with nonfamilial hypercholesterolemia receiving background statin therapy, while TRANQUILITY demonstrated sustained reductions in high-sensitivity C-reactive protein with the interleukin-6 (IL-6) inhibitor pacibekitug in patients with chronic kidney disease. DAN-RSV demonstrated that RSVpreF vaccination reduced RSV-related respiratory and cardiorespiratory hospitalizations across two seasons. Studies presented at ESC 2026 broadened the evidence base for cardiovascular prevention across pharmacologic therapy, imaging-guided risk assessment, blood pressure management, and vaccination.
Early-onset obesity is associated with adverse cardiometabolic risk factors and early vascular changes linked to atherosclerosis, yet evidence-based treatment options for young children remain limited. The purpose of the review is to examine current evidence for lifestyle, pharmacologic, and surgical interventions for obesity management in preadolescent children, with emphasis on cardiometabolic and atherosclerotic risk. Lifestyle and familybased behavioral interventions remain first line therapy but often produce modest and variable weight reduction. Pharmacologic options for children younger than 12 years are limited, emerging data suggest selected agents, including topiramate, lisdexamfetamine, glucagon-like peptide-1 receptor agonists and metformin can improve weight status and cardiometabolic risk factors in carefully selected patients. Bariatric surgery provides durable weight loss and cardiometabolic benefit and adolescents with severe obesity, though data and younger children are sparse. Available interventions may improve cardiometabolic risk profiles when appropriately applied early in life, but high-quality long-term data and preadolescent children are needed.
Apolipoprotein C-III (apoC-III) has emerged as a validated target for lowering triglycerides, triglyceride-rich lipoproteins, and remnant cholesterol. This review summarizes the biology of apoC-III, the genetic and clinical trial evidence supporting its inhibition, and remaining questions. Loss-of-function variants in APOC3 are associated with lower levels of triglycerides and reduced cardiovascular risk. Pharmacologic inhibition of apoC-III with RNA-based agents has led to substantial reductions in apoC-III and triglycerides across familial chylomicronemia syndrome (FCS), severe hypertriglyceridemia (sHTG), and moderate hypertriglyceridemia (mHTG). In FCS, agents volanesorsen, olezarsen, and plozasiran have demonstrated reductions in triglycerides and acute pancreatitis. In sHTG, olezarsen has extended this benefit to a larger, multifactorial population. In mHTG, olezarsen and plozasiran lower triglycerides, remnant cholesterol, non-HDL-cholesterol, and apolipoprotein B, but an imaging study with olezarsen demonstrated neutral findings on coronary plaque composition, and cardiovascular event reduction has not been demonstrated. ApoC-III inhibition provides a potent strategy for lowering triglycerides and triglyceride-rich lipoproteins. Its most immediate clinical role is in FCS and sHTG, where prevention of acute pancreatitis is the main objective. Its future as a cardiovascular therapy will depend on whether reductions in remnant cholesterol and apolipoprotein B translate into fewer atherosclerotic events in a dedicated cardiovascular outcomes trial.
Implementation science, a multi-method research area that integrates input from constituents and content experts, has emerged as an important tool in improving implementation of evidence-based practices. This review summarizes three ongoing implementation studies focused on identification of patients with significantly increased risk for atherosclerotic cardiovascular disease (ASCVD) due to genomic risk such as familial hypercholesterolemia (FH) within a single health system. Despite the existence of evidence-based guidelines for identifying individuals with increased risk for ASCVD from FH and managing their care to reduce risk, substantial care gaps exist in guideline implementation. These include patient understanding of the importance of heart disease prevention, clinician implementation of screening for risk factors, and adherence to recommended treatments. While guidelines often focus on the encounter between a patient and clinician, implementation science enlarges the field of study to encompass factors external to the encounter. These factors include multi-level barriers and facilitators to implementation. By developing strategies to overcome barriers and leverage facilitators, management can be improved for those with FH. Implementation science methods described herein are transferable to other health care settings, with a goal of improving preventive medicine practice and increasing adherence to evidence-based practices for FH.
