Despite a notable decline over the past few decades, cardiovascular disease (CVD) remains the leading cause of premature mortality in individuals with diabetes mellitus. Compared to individuals without diabetes, there is ~2-fold or higher increase in CVD and mortality in those with diabetes. While CVD-related complications are seen predominantly during adulthood, the atherosclerotic process begins in childhood and is accelerated in individuals with type 1 diabetes (T1D), and even more so in type 2 diabetes (T2D). While there are improved methods of achieving glycemic control, earlier recognition and management of CVD risk factors, and advances in treatment, an increase in the prevalence of both T1D and T2D among youth continues to present additional challenges, especially because newer medications are underutilized. In this review, we discuss the origin and progression of atherosclerosis in youth with both T1D and T2D, CVD risk factors, and current guidelines. We conclude with key clinical questions that urgently need to be addressed to increase risk factor screening rates and treatment to improve outcomes in this high-risk population. For complete coverage of all related areas of Endocrinology, please visit our on-line FREE web-text,
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