Unfavorable patterns of heart health through young adulthood linked to increased CVD risk later in life

Despite progress in past decades to reduce the burden of cardiovascular disease (CVD), it remains the leading cause of death in the U.S. and worldwide. Data within the past 10 years indicate deceleration and reversal of declines in CVD morbidity and mortality. These trends may be further worsened by the prevalence of low heart health, particularly among young adults.

A new study by researchers from Boston University Chobanian & Avedisian School of Medicine has found that among young adults, unfavorable patterns of heart health through young adulthood were associated with increased risk for CVD later in life.

While research has begun to characterize cardiovascular health in young adults and its long-term association with premature cardiovascular disease, few studies have examined longitudinal patterns of heart health in young adulthood. Our current observation indicates that change matters; improvements in heart health can decrease future risk, and the earlier it is attained and maintained, the better."

Donald Lloyd-Jones, MD, ScM, corresponding author, professor of medicine at the school and director of the Framingham Heart Study

In 2022, the American Heart Association created the concept of Life's Essential 8 (LE8) as a way for people to assess their current heart health and to find ways to measurably improve it by making simple lifestyle changes like eating better, being more active, quitting tobacco, getting healthy sleep, managing weight, controlling cholesterol and managing blood sugar and blood pressure. BU researchers looked at the LE8 scores of several thousand young adults starting at age 18 who were part of the Coronary Artery Risk Development in Young Adults/CARDIA study. They observed how those scores changed over 20 years, and then how those patterns related to poor outcomes such as heart attacks and strokes in the subsequent 20 years.

The researchers found that people whose LE8 scores were always high were at very low risk for later heart attacks and strokes. People who started with only moderate heart health and maintained it over time were at twice the risk, while people who went from moderate to low heart health over time were at 10 times higher risk for heart attacks and strokes.

According to the researchers, looking at patterns of change or the trajectories of heart health across early life can tell a lot about one's lifespan and healthspan. "We hope that young adults will focus on their heart health as soon as possible, in order to gain the biggest dividends in longer, healthier lives," adds Lloyd Jones.

These findings appear in JAMA Network Open.

Funding for this study was provided in part by scholarship award AWD00000263 from the American Heart Association (Dr. Guo) and the Research Intensive Scholarly Emphasis (RISE) Medical Student Fellowship from the Northwestern University Feinberg School of Medicine (Dr. Guo). The Coronary Artery Risk Development in Young Adults (CARDIA) is conducted and supported by grants 75N92023D00002 and 75N92023D00005 from the National Heart, Lung, and Blood Institute in collaboration with the University of Alabama at Birmingham, grant 75N92023D00004 in collaboration with Northwestern University, grant 75N92023D00006 in collaboration with the University of Minnesota, and grant 75N92023D00003 in collaboration with the Kaiser Foundation Research Institute.