 This is not a slice of pizza, but could perhaps be thought of as the result of too many slices of pizza. This is what the inside of our major arteries look like, in an advanced stage of atherosclerosis lined with fat and cholesterol. We know that coronary artery disease doesn't just magically appear, though. The disease begins during early childhood, progressing unrecognized for several decades to its often final and unexpected endpoint of chest pain, disability, or simply death. We need to remind ourselves that atherosclerosis begins in childhood, as fatty streaks in the arteries, which are the precursors of the advanced lesions that ultimately kill us. By our 20s, 20% of the inner surface of the artery coming off the heart is covered in fatty streaks. So 50 years ago, pathologists started raising the question of whether heart disease is best handled by cardiologists or by pediatricians. Because by their 30s, many young adults already have advanced coronary atherosclerosis. An intervention from our 30s on is actually what's called secondary prevention, just trying to mediate the ravages of the disease rather than prevent the disease itself. This advanced atherosclerosis is likely already present. And we're exporting the problem around the world. Young, thin, apparently healthy individuals, yet 97% of their collected arteries looked like this. So even in developing countries where they've acquired our eating habits, we're seeing an epidemic of heart disease and sudden death, that is, if you're not shot first. Moreover, the risk factors that correlate with the extent of such early lesions are the same risk factors that correlate with heart attacks later in life. In other words, it's the same disease just in the early stages. So pathologists, the ones doing the autopsies and all these young people and seeing all this coronary artery disease, began urging many years ago that preventive measures should be instituted earlier in life. We've known that fatty streaks exist in young children for over a century. But it wasn't until 1994 that a task force convened by the government came up with a radical idea. The strategic key and the greatest opportunity in preventing cardiovascular disease is to prevent the development of risk in the first place. In my video, Heart Disease Starts in Childhood, I noted that fatty streaks at the first stage of atherosclerosis were found in the arteries of nearly 100% of kids, by age 10, raised on the standard American diet. In recognition of this fact, the latest Academy of Pediatrics recommendation is that all kids get their cholesterol tested starting between the ages of 9 and 11. Of course, this has drug companies salivating at the thought of slipping statins into happy meals, but long-term drug intervention is costly and may be associated with adverse effects. They're talking about lifestyle modification. In my video, How Many Meet the Simple Seven, I revealed the breathtaking statistic that only about 1 in 2,000 US adults met the seven American Heart Association criteria for a heart-healthy lifestyle. What about American teenagers? Of the 4,673 adolescents aged 12 through 19 that were studied, zero made the cut. What was the main sticking point? Well, you know, most teen boys and girls don't smoke. The white bars show the percentage meeting the criteria. Most aren't overweight, but almost no one ate a healthy diet. Less than 1% of young men and women met a minimum of healthy diet criteria. This sorry state of affairs is what's behind this controversial paper suggesting that the current generation of US children and adolescents, our children, may be one of the first generations to be less healthy and have a shorter lifespan than their parents.