The burden of cholesterol accumulation through the lifespan: why pharmacological intervention should start earlier to go further?

Among the cardiovascular risk factors, cholesterol-rich atherogenic lipoproteins play a central role in the pathogenesis of atherosclerosis. In middle-aged adults, the size of the total atherosclerotic plaque burden is influenced by both the concentration of circulating atherogenic lipoproteins and by the total duration of exposure to these lipoproteins. This review describes the evidence supporting a causal link between life-long elevations in atherogenic lipoproteins and future risk of atherosclerosis; evidence strengthened by recent epidemiological, genetic and clinical data. By consequence, adolescence and early adulthood are a crucial time for determining later cardiovascular disease risk. Arguments showing that early optimal lipid control leads to improved outcomes will be presented, and suggestions put forward for how those most at risk should be identified and managed.