Pediatric epidemiology programs have established that the major adult cardiovascular (C-V) diseases, coronary-artery disease, and essential hypertension, begin in childhood. Cardiovascular risk factors change during periods of growth and development, and there are distinct ethnic (black-white) and male-female differences that relate to adult heart disease. These risk factors have been shown to "track" over a 15-year period and are predictive of adult levels. Secular trends show increasing adiposity in the general population of children; an overall weight gain of 2 kg occurred during the decade from the 1970s to the 1980s, and approximately 5 kg during the decade from the 1980s to the 1990s. In all likelihood, increasing obesity is related to a more sedentary lifestyle. Cardiovascular risk factors also tend to cluster, for example, obesity correlates with higher blood pressure and with adverse serum lipoprotein changes. Further, a central distribution of obesity clusters with multiple risk factors in the insulin-resistant syndrome. Importantly, antemortem risk factors relate to actual C-V lesions found at autopsy. Lesions of a progressive nature occur in coronary vessels, which can ultimately result in clinical coronary heart disease. The development of lesions lag in young women at an equivalent age and with similar levels of risk factors. In addition, ethnic differences are noted in the development of C-V changes related to atherosclerosis and hypertension. The demonstration of C-V disease in early life gives credibility to risk-factor examination of children and the need for beginning of prevention in early life.