In recent years there has been a strong emphasis from both medical and nonmedical communities to improve overall cardiovascular health. Continued attention has been focused on finding improved treatment regimens, and, encouragingly, increased attention is being directed toward prevention strategies for coronary heart disease. Emphasis on heart-healthy diets, fitness, and the now commonplace free blood pressure and cholesterol screenings have become part of our daily life.Multiple studies have demonstrated that atherosclerosis begins in childhood, and increasingly, the need for prevention to begin during childhood is being highlighted. Preventive cardiology in children, however, has long relied on adult data for definitions of risk factors, study protocols, and norms.Gradually, the pediatric data is becoming available. Elevated cholesterol levels, hypertension, obesity, and other risk factors defined in adults are all areas of intense interest in the pediatric population. This brief review of preventive cardiology in children provides a look at the risk factors for adult coronary heart disease as they relate to children, the current recommendations (and associated controversies), and a summary of some of the most recent clinical trials.