Book excerpt: BACKGROUND AND AIM Atherosclerosis is the most common cause of cardiovascular disease (CVD) and has its origin early in life. The prevalence of classic CVD risk factors like smoking, overweight, hypertension and unfavorable blood lipids in childhood and adolescence is associated with an increased risk for CVD in adulthood. Therefore this study aims to assess vascular changes and predictors for early vascular ageing (EVA) in a large cohort of healthy Tyrolean adolescents.METHODS Volunteering Tyrolean schools and companies were invited to take part in this regional cohort study. Common risk factors for CVD like smoking, activity, and diet were assessed as well as anthropometric data (BMI, blood pressure) and blood lipids. Vascular changes were evaluated by measuring intima-media-thickness of the common carotid artery (cIMT) by high resolution ultrasound as a marker for subclinical atherosclerosis.RESULTS 1573 (691 male, 882 female) adolescents with a mean age of 16 years were included in this analysis. 1556 participants had ultrasound measurement of cIMT. In a multivariable linear regression analysis male sex, BMI, daily physical activity and systolic blood pressure showed a positive relation to mean cIMT. Maximum cIMT was predicted by sex, BMI and systolic blood pressure. CONCLUSION Risk factors for atherosclerosis are present in Tyrolean adolescents and are associated with early vascular aging. The positive association between physical activity and mean cIMT may be explained by a non-atherosclerotic adaptation process. Maximum cIMT as a marker for first atherosclerotic lesions is not affected by physical activity.