Fatty vessels shed tonnes on programmed cardiovascular risk

Cardiovascular disease remains one of the greatest killers in the world today, causing more than a quarter of all deaths in the UK (https://www.bhf.org.uk/for-professionals/ press-centre/facts-and-figures). It is common knowledge that cardiovascular risk is determined by the interaction between our genetic make-up and lifestyle risk factors, such as smoking, obesity and lack of exercise. There is increasing awareness that the gene–environment interaction before birth may be just as, if not more, important in setting a risk of cardiovascular disease, through a process known as developmental programming (Giussani & Davidge, 2013). In humans, the best evidence to support developmental programming comes from studies of obese women who have fallen pregnant before and after having bariatric surgery (Guénard et al. 2013). These studies show that siblings born before the surgery have an increased risk of cardiovascular disease compared to those born after. Therefore, such studies highlight that changes in the environment even within the same womb can programme a differential risk of cardiovascular disease in offspring of the same family. This provides strong evidence in humans that the quality of the environment experienced during critical, early periods of development directly influences long-term cardiovascular health. Unsurprisingly, these concepts have renewed and amplified a focus on prevention rather than treatment to reduce the burden of cardiovascular disease, and for preventative medicine to start as early as possible in the developmental trajectory rather than waiting to treat disease after it has become irreversible. In this issue of The Journal of Physiology, Badran et al. (2019) investigated the effects of obstructive sleep apnoea during pregnancy on cardiometabolic function in the adult offspring using an established mouse model. Obstructive sleep apnoea is characterized by episodes of intermittent hypoxia, which promote oxidative and inflammatory stress, and increase the risk of cardiovascular dysfunction in affected patients (Badran et al. 2019). However, animal models have not addressed the effects of maternal obstructive sleep apnoea during pregnancy on the