This article reviews important advances in the understanding and treatment of hypercholesterolemia and persistently high blood pressure in children. Two plant sterols, sitosterol and sitostanol, have been tested in prepubertal and adolescent children with hypercholesterolemia and appear promising. The advantages and disadvantages of family history in screening algorithms for atherosclerotic disease are discussed. Additionally, the apolipoproteins are being used more frequently to screen for cardiovascular risk. A rare genetic disease, familial defective apolipoprotein B-100, causes hypercholesteroiemia. The distinction between this disease and familial hypercholesterolemia has therapeutic implications. Two studies show that in utero exposures influence the future development of hypertension. Intrauterine cocaine exposure was associated with persistently elevated blood pressure during later childhood. The mechanism may involve the sympathetic nervous system. Retarded fetal growth appears to be a risk factor for the presence of hypertension during adult years in men.