Background: In the late 1960s, Finland had the world’s highest coronary heart disease mortality. Atherosclerosis has its roots in childhood. Childhood risk factors are associated with risk factors in adulthood that predict arterial changes, surrogate markers for atherosclerosis. Since the 1960s, coronary heart disease mortality has decreased over 80%. Over two thirds of the reduction in mortality can be explained by change in risk factor levels. Nevertheless, atherosclerotic cardiovascular diseases are still the leading cause of death and disability in Finland and worldwide. 

Aims: The aims of this thesis were to: study risk factor levels and their changes in Finnish adult population; investigate how many childhood measurements of lipids and blood pressure are needed to optimize the prediction of adult risk factor levels and arterial changes; and determine if adding information on genetic variants to child lipid levels improves prediction of adulthood dyslipidemia. 

Participants and methods: This thesis uses data from the Cardiovascular Risk in Young Finns Study, a prospective cohort of Finnish children initiated in 1980. Over 31 years, cardiovascular risk factors were measured from participants at several follow-ups. In the most recent follow-up performed in 2011, 57% of the original study population participated. 

Results: In 2011, the previously observed favorable trends in cholesterol levels had leveled off and over one-third of participants had prediabetes. Two lipid and blood pressure measures in childhood significantly improved prediction of adult dyslipidemia and hypertension over one measurement. Use of genetic risk score approach combined to traditional risk factors significantly enhanced the prediction of adulthood dyslipidemia over conventional childhood risk factors. 

Conclusions: Favorable trends in cardiovascular risk factor levels appear to be leveling off in Finland. At least two measures of blood pressure and lipids should be used in childhood assessment for future cardiovascular disease risk. Genetic information can help identify children at risk for adult dyslipidemia.