HEART DISEASE IS THE leading cause of death in the U.S. But for most with atherosclerosis – or hardening of the arteries, the most common cause of cardiovascular disease, which can lead to heart attack and stroke – it doesn’t catch up with them until later in life. Yet what happens physiologically from lifestyle choices made decades prior can have a significant impact, even tracing all the way back to parents’ choices before a child is born.

For kids with congenital heart disease, certainly this is a point of focus from a young age. Some kids born with heart defects require surgery. But there’s reason to consider long-term cardiovascular health in other children as well, as the origins of heart disease that isn’t congenital can still have roots in childhood and adolescence. “We know that these problems and what’s called atherosclerotic heart disease – where you have lipid or cholesterol buildup in arteries – can begin at a very early age,” says Dr. Gregory Perens, a pediatric cardiologist at UCLA Mattel Children’s Hospital in Los Angeles.

Beyond genetics, the earliest risk factors include maternal smoking while the child is still in utero. From 0 to 12 months, experts advise breastfeeding, and doing so exclusively for the first 4 to 6 months – as the sole source of nourishment for the baby; this has been found to lower a child’s later risk of heart disease, compared with bottle feeding, Perens notes. “Obviously not all children can be breastfed,” he says. “But if that’s possible, that’s the recommendation.”

Fast-forwarding, as children get older, not only do parents but kids, too, have a say in reducing health risk factors. For teens in particular – as they begin to take the reins in other areas of their lives – doctors say this is great time to begin prioritizing heart health and, with support from parents, to work together as a family to lower their risk for developing heart disease.

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