Introduction. The global prevalence of obesity is on the rise [1]. The well established correlation between excess weight and cardiovascular disease has been raising concerns regarding this pandemic [2, 3]. Paediatric obesity is also on the rise, which may indicate the development of a growing incidence of obesity-related comorbidities and cardiac patients in the future [4]. Assertive action in this direction requires a keen knowledge of the mechanisms that clarify the relationship between obesity and cardiovascular disease. Aim of the study. To provide an overview of the current literature regarding the influence of paediatric obesity on cardiovascular risk and the underlying pathophysiological mechanisms. Materials and methods. We performed literature searches using the Medline/ PubMed databases and referred to international guidelines where applicable. Results and conclusions. The complex mechanisms that establish the link between obesity and cardiovascular risk begin in the early years of childhood and contribute to the formation of a cluster of detrimental characteristics that include physical inactivity, unhealthy eating habits, smoking and an altered metabolism defi ned by elevated insulin resistance and dyslipidemia. It is reasonable to assume that there is a high chance that today’s obese children might become tomorrow’s cardiac patients. This knowledge encourages the development of protocols to better defi ne the cardiovascular risk of obese children and to take preventive action where possible.