Atherosclerosis, coronary artery disease, and stroke. These conditions affect young adults, middle-aged adults and seniors. While technically true, but with exceptions, the heart attack or stroke that affects someone at age 45, 55 or 65 years does not just occur “out of the blue”. In most cases, there has been underlying pathology developing and affecting their blood vessels for many years. Although the pathogenesis of narrowing in blood vessels is multifactorial and undergoing continued investigation and debate, it is clear that cholesterol build-up in the vessel wall plays an important role. This is a process that takes many years or even decades to develop and, therefore, what your teen eats now can affect their risk of cardiovascular disease later in life. Furthermore, they tend to carry the eating habits that they develop as a child and teen with them through life. It is even more difficult to convince people that if they are not overweight or ‘fat’, their vessels and heart are not either. That is far from the case. While a correlation does exist between obesity and heart disease it is not cause and effect per se, but may be another marker. Plenty of fit, athletic, thin people develop severe vascular and heart disease. Thin people can have very elevated triglycerides and cholesterol and obese people can have very normal or low levels. The fact is that 17% of teens have evidence of atherosclerosis and 50% of 40 year-olds will have evidence of it as well. Having operated on many children, teens and young adults, I have certainly come across my share of young hearts covered in fat, and who have yellow streaks and true thickened plaques in the aorta and other vessels. Think about that the next time you order a double cheeseburger. Atherosclerosis starts early in life and progresses, but there are things one can do to limit or prevent its development. Do not smoke, avoid obesity and secondary diabetes, exercise regularly, eat fruits and vegetables, and limit high cholesterol and fatty foods in meals. Moderate and balance the tasty (but bad for you) foods with healthy foods.