The subspecialist has been historically on the forefront of diagnosis and management of cardiovascular disease in our society. Recently, however, we have seen the focus shifting from high technology to include primary care and prevention. Cardiovascular risk evaluation has been identified as the thrust of the 1990s, and there is a reemergence of the generalist as a potential leader in cardiovascular care. It is now recognized that efforts early in life to promote cardiovascular health may have dramatic impact beyond the pediatric age. Five major areas are identified as targets for cardiovascular health promotion in childhood: obesity, cardiovascular fitness, hypertension, hypercholesterolemia, and smoking prevention. Pediatricians, as well as family physicians, must recognize their critical role in the promotion of cardiovascular health. The focus should not be limited to traditional childhood diseases but also to adult diseases that have their origins in childhood. Appreciation of the scientific findings generated by studies such as the Bogalusa Heart Study should influence the pediatrician in assuming a major role in prevention of adult heart and other chronic diseases.