An article written by Dr Edward Leatham, Consultant Cardiologist

Tags: Cholesterol, Coronary heart disease, LDL, NH1  search website using Tags to find related stories.

Who Is This Article For?

This guide is written for two important groups:

1. Health-conscious individuals under 20 years old – young people who want to understand how early decisions can impact their long-term heart health.
2. Parents or caregivers with a personal history of heart disease – families seeking practical steps to reduce inherited risk and safeguard the cardiovascular health of the next generation.

Why Cardiovascular Prevention Matters Before 20

It may seem unusual to talk about heart disease in teenagers and children, but the groundwork for heart health is laid early in life. Habits formed in youth often carry into adulthood, and many cardiovascular risk factors—like high cholesterol, high blood pressure, or obesity—can be silent, slowly progressing without symptoms.

In families where heart disease runs deep, understanding risk and prevention from a young age can be life-changing.

Family History and Genetics: Know Your Risk

One of the strongest predictors of heart disease is family history, particularly if a first-degree relative (parent or sibling) developed heart disease before the age of 60. Even second-degree relatives (like grandparents or uncles) can carry relevance, especially in younger individuals.  Roughly half of risk can be attributed to genetic predisposition and half from environmental factors such as smoking, diet and lifestyle, so while it seems sensible for everyone to be aware of how lifestyle and diet can impact your future health, those with a family history of heart disease should be the most proactive. 

What Family History Should Raise Concern?

Note: Tendon xanthelasma at any age, arcus cornealis < 40 yrs (a white ring around the iris), or yellow patches near the eyes at any age may suggest FH and should be evaluated by a clinician.

Key Screening Tests to Consider Before Age 20

Even without symptoms, some simple and non-invasive tests can reveal early risk:

• 12-lead ECG – can detects inherited heart rhythm conditions such as long QT syndrome
• Lipid panel – checks cholesterol levels (total, HDL, LDL, triglycerides)
• Lp(a) – identifies elevated lipoprotein(a), a hereditary risk factor
• HbA1c and CarbR test – assess glucose control and diabetes risk
• Waist-to-height ratio (WHR) – WHR > 0.5 suggests central obesity

When Are These Tests Essential?

If you or your child meet any of the following, speak to your GP, or alternatively arrange to test it for yourself:

• Any first-degree relative with heart disease diagnosed before 60
• Evidence of xanthelasma or arcus cornealis
• BMI > 30 or central fat distribution
• Known family history of familial hypercholesterolaemia (FH) or high LP(a)

What Can Families Do to Reduce Risk?

1. Start With Lifestyle: Build Heart-Healthy Habits Together

• Exercise regularly: Aim for 60 minutes of moderate to vigorous activity daily.
• Avoid or minimise cigarette smoking 
• Limit screen time: Encourage active play and reduce sedentary behaviour.
• Get enough sleep: Poor sleep is linked to obesity and insulin resistance.
• Talk about emotions: Chronic stress and anxiety can affect heart health.

2. Eat Smart, Eat Together

The food we eat as children affects our taste preferences and habits for life.

Key Strategies for Heart-Healthy Eating:

• For those that can have a sufficient and balanced diet, avoid highly processed snacks (crisps, processed meats, instant noodles), as although convenient, low cost and often delicious these contain saturated fats and carbohydrates that in the long term, can contribute to the adverse LDL and glucose profile linked to heart disease.
• Replace sugary drinks and sodas with water, milk, or unsweetened options
• Choose whole fruits over fruit juice or smoothies, which can be high glycaemic
• Chose low glycaemic index carbs – swap white bread and pastries for oats, legumes, and brown rice
• Include healthy fats – olive and rape seed oil, avocados, nuts, seeds, and oily fish
• Take time to eat as a family and consider CGM monitoring. If this shows unhealthy glucose excursions, get your HbA1c checked and explore ‘carb cutting’ strategies and  ‘glucose hacks’ such as salads before carbohydrates [8] and the Harvard plate [9].

Breakfast: More Important Than You Think

The modern Western breakfast—high in sugar, starch, and refined carbohydrates—can deliver a glucose spike to many people that may promote insulin resistance, weight gain, and type 2 diabetes over time.

Common Breakfast Pitfalls:

• Sugary cereals
• White bread/toast, pancakes or croissants
• Fruit juice, smoothies, maple syrup
  

These high-carb starts can overwhelm the body’s glucose regulation system, especially in genetically susceptible individuals.

Smarter Alternatives:

• Eggs, cheese, or Greek yogurt
• Whole grain porridge with nuts
• Avocado and other foods high in unsaturated fats
• Raw vegetables with hummus
• Fermented dairy (e.g., kefir)
• Savoury breakfast choices such as peppers, mushrooms, broccoli combined with eggs.

Families affected by obesity or type 2 diabetes should prioritise low glycaemic, high-protein breakfasts to stabilise blood sugar and reduce hunger through the day.

Fasting: Ancestral Clues to Modern Nutrition

Our ancestors evolved during feast and famine cycles. Human metabolism developed flexible fuel systems, allowing the body to run on glucose or fats depending on availability of food.

In today’s world of constant food access, those ancient genes—which once helped survive famine—may now promote fat storage and obesity.

Intermittent fasting approaches (under medical supervision), or simply reducing constant snacking, may be worth exploring in older teenagers or adults with a family history of metabolic syndrome.

Spotting Early Signs of Cardiovascular Risk

Even in youth, subtle physical signs can provide clues:

• Arcus cornealis: a grey-white arc around the iris (especially <40 years)
• Xanthelasma: yellowish deposits around the eyes
• Tendon thickening or xanthomas: especially at the Achilles tendon

Any of these signs, and/or a positive family history, warrants a lipid profile to test for familial hypercholesterolaemia (FH).

FH affects 1 in 250 people, yet most go undiagnosed.

What Should Parents Do If FH Is Suspected?

Familial hypercholesterolaemia affects 1 in 250 people in the UK. The majority of affected individuals are not aware they have a problem until it is too late. The condition causes high LDL cholesterol from birth and leads to serious and even fatal coronary heart disease as young as mid 20s. Lipid experts will aim to detect it before the age of 10 to ensure early treatment and to try and get a lifetime cvd risk that is the same as a person without CVD risk

It can be suspected in patients with family history of heart disease <60, and/ or if you have an Total Cholesterol >7.5 or LDL > 4.9 mmol/L [9].  If you suspect you may be affected:

• Speak with your GP and request a lipid panel for your child
• Ask about LP(a) and cascade screening for family members
• Refer to national FH networks (e.g., NHS or RACGP guidelines)
  

Medication

There are now multiple treatments available for FH, including statins and PCSK9 inhibitors. Children tolerate lipid lowering medication very well.  It is worth noting that identifying affected girls at a young age is vital, as they may choose not to continue medication when trying to get pregnant, are pregnant or when breastfeeding..

Building a Heart-Healthy Home Environment

At Home:

• Cook meals together using whole ingredients
• Keep processed snacks out of reach and out of sight
• Offer low-carb snacks: nuts, olives, sliced vegetables
• If you have a family history of high blood pressure or stroke, considered using herbs and spices instead of salt
• Prioritise water and herbal teas over sugary drinks

At School:

• Advocate for healthier school meals
• Support restrictions on fast food advertising and access
• Educate children on reading nutrition labels and food awareness

As Role Models:

• Children mimic what they see—lead by example with exercise, meal choices, and stress management
• Normalise regular check-ups and discussions about health

In Summary: What Can We Do Now?

Final Thoughts

Preventing cardiovascular disease starts earlier than most people think. For health-conscious young people and families with heart disease in their lineage, early awareness, lifestyle choices, and targeted testing can make a world of difference. This isn’t just about adding years to life—it’s about adding healthy, active years free of cardiovascular limitations.

Let’s create a generation where heart disease is the exception, not the rule.

Key messages

1. When it comes to coronary heart disease, LDL Cholesterol is considered to be the main determinant of the build up in coronary plaque that starts early in life.
2. If your LDL cholesterol exceeds 4.9 mmol/L and one or more relatives affected by heart disease (<60), then you should see your GP to discuss the possibility of familial hypercholesterolemia
3. Diet and lifestyle are major contributors to personal risk of future heart disease. Lifelong habits learnt from a young age can therefore affect your future health.

For other stories related to cholesterol, coronary heart disease, and LDL, explore the archives by entering a tag under the search function above.

Resources for Further Reading

1. 1. Cardiovascular Prevention: Why Waiting Until 60 Is Too Late
   2. Test your health at home (and CarbR test)
   3. https://www.nhs.uk/health-assessment-tools/calculate-your-waist-to-height-ratio
   4. LDL: the lower the better
   5. Cholesterol measuring 2024 guidance 
   6. Gain of function mutations in PCSK9 regulators
   7. The latest ESC and locally developed guidelines on LDL targets
   8. My glucose spikes: so what?
   9. The Harvard healthy eating plate
   10. Familial Hypercholesterolaemia NHSE
   11. RACGP FH Guidelines
   12. NHS: Obesity in Children

The Naked Heart is an educational project owned and operated by Dr Edward Leatham. It comprises a series of blog articles, videos and reels distributed on Tiktok, Youtube and Instagram  aimed to help educate both patients and healthcare professionals about cardiology related issues.

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