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Published on: September 26, 2018
Associations of Late Adolescent or Young Adult Cardiovascular Health With Premature Cardiovascular Disease and
Amanda M Perak1, Hongyan Ning2, Sadiya S Khan3
1Department of Preventive Medicine, Northwestern University, Chicago, Illinois; Department of Pediatrics, Northwestern University, Chicago, Illinois.
Insights
Maintaining high cardiovascular health in young adulthood significantly lowers the risk of premature cardiovascular disease (CVD) and mortality over 32 years. This highlights the critical importance of cardiovascular health (CVH) for long-term well-being.
Area of Science:
- Cardiology and Public Health
- Epidemiology
- Preventive Medicine
Background:
- Cardiovascular health (CVH) in adolescence and young adulthood is linked to subclinical cardiovascular disease (CVD).
- Limited data exist on the association between early-life CVH and actual CVD events or mortality.
- This study investigates the long-term impact of CVH in young adults on premature CVD and mortality.
Purpose of the Study:
- To examine the association between cardiovascular health (CVH) measured in young adulthood (ages 18-30) and the risk of premature cardiovascular disease (CVD) events.
- To assess the relationship between early-life CVH and cause-specific mortality over a 32-year follow-up period.
- To determine the population-attributable risk of suboptimal CVH for CVD events and mortality.
Main Methods:
- Analysis of data from the Coronary Artery Risk Development in Young Adults (CARDIA) Study.
- Scoring of baseline cardiovascular health (CVH) using Life's Simple 7 metrics, categorized as high, moderate, or low.
- Adjudication of cardiovascular disease (CVD) events and mortality over 32 years, with adjusted Cox models and calculation of population attributable fractions.
Main Results:
- Among 4,836 participants, 28.8% had high CVH at baseline (mean age 24.9 years).
- High CVH was associated with significantly reduced adjusted hazard ratios for CVD (0.14) and CVD mortality (0.07) compared to low CVH.
- Suboptimal CVH (moderate or low) accounted for substantial population-attributable fractions for CVD (63%) and CVD mortality (81%).
Conclusions:
- High cardiovascular health (CVH) in young adulthood is strongly associated with very low rates of premature cardiovascular disease (CVD) and mortality.
- These findings underscore the critical importance of achieving and maintaining optimal CVH during late adolescence and young adulthood.
- Interventions promoting high CVH in early life may have a profound impact on reducing the burden of premature CVD and mortality.
Background:
When measured in adolescence or young adulthood, cardiovascular health (CVH) is associated with future subclinical cardiovascular disease (CVD), but data are lacking regarding CVD events or mortality.
Objectives:
This study examined associations of CVH at ages 18 to 30 years with premature CVD and mortality.
Methods:
This study analyzed data from the CARDIA (Coronary Artery Risk Development in Young Adults Study). CVH was scored at baseline (1985 to 1986) using Life's Simple 7 metrics and categorized as high (12 to 14 points), moderate (8 to 11), or low (0 to 7). CVD events and cause-specific mortality were adjudicated over 32 years of follow-up. Adjusted associations were estimated using Cox models and event rates and population attributable fractions were calculated by CVH category.
Results:
Among 4,836 participants (mean age: 24.9 years, 54.8% female, 50.5% Black, mean education: 15.2 years), baseline CVH was high (favorable) in 28.8%, moderate in 65.0%, and low in 6.3%. During follow-up, 306 CVD events and 431 deaths occurred. The adjusted hazard ratios for high (vs. low) CVH were 0.14 (95% confidence interval [CI]: 0.09 to 0.22) for CVD and 0.07 (95% CI: 0.03 to 0.19) for CVD mortality, and the population attributable fractions for combined moderate or low (vs. high) CVH were 0.63 (95% CI: 0.47 to 0.74) for CVD and 0.81 (95% CI: 0.55 to 0.92) for CVD mortality. Among individuals with high CVH, event rates were low across sociodemographic subgroups (e.g., CVD rates per 1,000 person-years: age 18 to 24 years, 0.64; age 25 to 30 years, 0.65; men, 1.04; women, 0.36; Blacks, 0.90; Whites, 0.50; up to/through high-school education, 1.00; beyond high-school education, 0.61).
Conclusions:
High CVH in late adolescence or young adulthood was associated with very low rates of premature CVD and mortality over 32 years, indicating the critical importance of maintaining high CVH.
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