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This study aimed to evaluate the cardiovascular risk factors changes in children and adolescents with CHD and to investigate factors associated with carotid intima-media thickness at 5-year follow-up. This study included 101 children and adolescents with CHD. Clinical characteristics were assessed at baseline and follow-up. Lifestyle behaviors were evaluated at baseline. Cardiovascular risk factors changes were evaluated. Carotid intima-media thickness was measured using ultrasound at follow-up. Factors associated with carotid intima-media thickness at 5-year follow-up were examined using linear regressions and sensitivity analyses stratified by waist circumference changes was performed. The median WC and triglycerides significantly increased, while blood pressure, total cholesterol, low-density lipoprotein and non-high-density lipoprotein cholesterol significantly decreased over 5-years. In multivariable analyses, coarctation of aorta (\u03b2: 0.035 95%CI: 0.009;0.061) and increased waist circumference (\u03b2: 0.022 95%CI: 0.002;0.041) were associated with carotid intima-media thickness at 5-year follow-up. In sensitivity analyses, coarctation of aorta (\u03b2: 0.054 95%CI 0.002;0.087) and baseline unhealthy eating habits cluster (\u03b2: 0.031 95%CI 0.013;0.061) were associated with carotid intima-media thickness at 5-year follow-up only in increased waist circumference group. Children and adolescents with coarctation of aorta and increased waist circumference were prospectively associated with carotid intima-media thickness. These findings emphasize the importance of group-risk stratifications and early diagnosis and treatment of cardiovascular risk with multi-professional approach in this population.<\/jats:p>","DOI":"10.1007\/s00246-026-04479-7","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T13:46:31Z","timestamp":1789652791000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cardiovascular Risk Factor Trajectories and Their Association with Subclinical Atherosclerosis in Children and Adolescents with Congenital Heart Disease: Findings from a 5-Year Follow-up Study"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6460-0572","authenticated-orcid":false,"given":"Michele","family":"Honicky","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2773-0815","authenticated-orcid":false,"given":"Silvia M.","family":"Cardoso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0280-0151","authenticated-orcid":false,"given":"Luiz R. 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