Since 1973, the Bogalusa Heart Study has followed a community-based cohort of Black and White individuals from childhood into adulthood to define the early origins and life-course trajectories of cardiovascular risk. Obesity, elevated blood pressure, dyslipidemia, and insulin resistance arise in childhood, track into adulthood, and cluster to accelerate cardiovascular disease, with marked racial and socioeconomic disparities. Childhood behaviors—diet, physical activity, sedentary time, and tobacco use—interact with social and environmental contexts to shape lifelong risk. Subclinical vascular and cardiac changes are detectable with carotid intima-media thickness, pulse wave velocity, and echocardiography, identifying vulnerable developmental windows for intervention. Emerging evidence also links these cardiometabolic burdens and subclinical phenotypes to midlife cognitive outcomes. Bogalusa findings have informed national screening and school-health policies and motivate multilevel primordial prevention—spanning family, school, clinical, and community settings—to reduce lifetime cardiovascular risk and advance equity. This chapter synthesizes the longitudinal evidence and translates it into practical, targeted prevention approaches.