It is becoming clear that, while the number of people dying from heart disease continues to fall each year in countries such as the UK, the number of people suffering from this disease is rising.¹ In part this is due to the age structure of developed societies, but it also emphasises that we are still far from understanding the causes of heart disease. Until we do, prevention will be difficult. The concept that prenatal and early childhood factors play an important role in this aetiology is now well established² and this theory and its implications are being explored.^3,4

The collection of short reviews in this symposium highlights areas of current research of direct relevance to cardiovascular disease. Mark Hanson and Peter Gluckman examine how their concept of predictive adaptive responses may be applied to vascular endothelial dysfunction, as this plays a key role in the development of vascular and related disease such as metabolic syndrome. Kent Thornburg and Samantha Louey review the evidence that prenatal factors can alter cardiac development in ways which predispose to later disease. Omar Khan and Cliff Shearman enquire whether there may also be a role for early developmental factors in the origins of peripheral vascular disease, an area which has received less attention in this context. Helena Gardiner reviews the effects of changes in load on fetal cardiac development, as processes which determine the limits of compensation underlie possible later failure. Finally, Julian Boullin and John Morgan draw attention to the role of changes in cardiac rhythmogenesis, very little investigated in comparison to hypertension and atherogenesis as components of the developmental origins of heart disease.

Far from providing definite answers, the symposium draws attention to the need for further research, from animal and human physiology to epidemiology, if the insights from the developmental origins of disease concept are to be exploited in terms of cardiovascular disease prevention.