Cardiovascular risk factors begin in childhood and are predictive of cardiovascular risk in adulthood. Observations in the Bogalusa Heart Study have shown an important correlation of clinical risk factors in early life with anatomic changes in the aorta and coronary vessels with atherosclerosis and cardiac and renal changes related to hypertension. These observations have been extended by echo Doppler studies of carotid artery intima media thickness (IMT). A close association of risk factors in young adults, 20-38 years of age, occurs with IMT, and a marked increase is noted as numbers of risk factors increase. More extensive changes seem to occur in the bulb or bifurcation area. This area may be an earlier marker of disease. Observations of risk factors in young individuals and noninvasive studies of structural changes of the cardiovascular system have strong implications for prevention by cardiologists.