Association between ADHD history and "Life's Crucial 9" cardiovascular risk factors in young adults

Symptoms of attention-deficit/hyperactivity disorder (ADHD) often persist into adulthood, increasing cardiovascular disease (CVD) risk. This study extends our previous research, by examining associations between ADHD and modifiable CVD risk factors, incorporating the recently proposed Life's Crucial 9 (LC9) metric.

We conducted a prospective analysis using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health). ADHD was identified at Wave IV (mean age 28.4), and at Wave V (approximately 9 years later), we assessed nine CVD risk components, including smoking, physical activity, diet, sleep, body mass index, lipids, blood glucose, blood pressure, and psychological health status A cumulative LC9 risk factor count (range 0-9) was calculated by summing adverse components, with higher counts indicating greater LC9 risk factor burden. Survey-weighted linear, logistic, and multinomial logistic regression models were used to estimate these associations, adjusting for potential confounders.

Among 10 913 participants (mean age 28.4 years; 49.4 % male), 492 (4.7 %) reported an ADHD diagnosis. Over 9 years of follow-up, ADHD was associated with a higher LC9 risk factor count. Compared with individuals without ADHD, those with ADHD had higher odds of cigarette smoking (OR, 1.66 [95 % CI, 1.26-2.18]), sleep problems (OR, 1.41 [95 % CI, 1.09-1.82]), and anxiety and/or depression (OR, 3.31 [95 % CI, 2.50-4.42]). In joint-category analyses, participants with both ADHD and anxiety and/or depression showed the most adverse profiles, particularly for smoking, sleep problems, hyperlipidemia, and hypertension.

ADHD in young adulthood is associated with an unfavorable cardiovascular risk profile. Psychological comorbidity substantially amplifies this burden, highlighting the importance of integrating mental health screening into LC9-based cardiovascular prevention strategies.