The American lifestyle is becoming increasingly unhealthy. "Supersizing" is now a household term. For a number of reasons, cardiovascular disease (CVD) is the number one killer of Americans today. While most of the clinical burden of CVD lies in adulthood, research is making it clear that the atherosclerotic process (i.e., the building up of plaque on artery walls) begins early and is progressive throughout life. Therefore, a new urgency should be placed on early detection and aggressive treatment of risk factors in order to head off the epidemic of CVD in America. The American Heart Association (AHA) and the American Academy of Pediatrics (AAP) have issued recent policies regarding this important matter. This article will discuss the strongest risk factors for CVD and the screening for and treatment of lipid abnormalities in childhood and adolescence in order to lower the lifelong risk of death and morbidity from the disease.