Background-Obesity and familial dyslipidemia in children are associated with accelerated atherosclerosis by pathological examination. We sought to determine whether these children had increased carotid artery intima-media thickness (CIMT), a measure of subclinical atherosclerosis similar to 45-year-old adults. Adult CIMT percentile tables were used for comparison because normative CIMT data for children are limited. Methods and Results-Seventy children, ages 6 to 19 years, with obesity-and atherosclerosis-promoting risk factors such as dyslipidemia, hypertension, insulin resistance, and tobacco smoke exposure, or with familial dyslipidemia, underwent carotid artery ultrasound. Advanced "vascular age" (VA) was defined as having maximum CIMT that was Ն25th percentile for raceand sex-matched 45-year-old adults. Mean age was 13.0Ϯ3.3 years. Forty (57%) of 70 children had body mass index Ն95th percentile for age and sex. Maximum CIMT for obese children was 0.53Ϯ0.05 mm and for familial dyslipidemic children was 0.52Ϯ0.04 mm. Advanced VA was seen in 30 (75%) of obese children and 22 (73%) of familial dyslipidemic children. Thirty (75%) of obese children had Ͼ3 mutable atherosclerosis-promoting risk factors; these children had a nonsignificantly higher maximum CIMT compared with obese children with Յ3 risk factors (0.54Ϯ0.06 mm versus 0.52Ϯ0.03 mm, Pϭ0.07). Obese children with high fasting triglyceride levels were more likely to have advanced VA. Conclusions-VA is advanced and comparable in obese children with atherosclerosis-promoting risk factors and in children with familial dyslipidemia. Advanced VA is prevalent in obese children with high fasting triglyceride levels. (Circ Cardiovasc Imaging. 2010;3:8-14.)

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