Abstract 69: Trajectory of Cardiovascular Health Across Childhood and Adolescence in Project Viva

Introduction: The American Heart Association recently put forth the Life’s Essential 8 (LE8) algorithm to assess cardiovascular health (CVH) status based on 8 health and behavioral factors. Few studies, however, have characterized the natural history of CVH status across development or identified sociodemographic determinants of CVH trajectories in children. We sought to address this research gap using data from Project Viva, a pre-birth cohort in eastern Massachusetts. Methods: We applied the LE8 algorithm to derive CVH score (range 0-100 points) in early childhood (median age 3.2y), mid-childhood (7.7y), early adolescence (13y), and late adolescence (17.5y). We used segmented mixed-effect models to characterize sex-specific CVH trajectories across these life stages and estimate three subject-specific trajectory parameters: timing of inflection point when CVH score declines; slope before and after the inflection point. We used linear regression models to assess the association of child race and ethnicity, mother’s education level, and annual household income with each trajectory parameter. Results: Among 1,523 children included, 48.7% were female, 3.5% Asian, 15.2% Black, 4.8% Hispanic, 11.5% Other, and 65.0% White. The mean (SD) CVH score was 82.6 (8.6) points in early childhood, 84.1 (8.3) points in mid-childhood, 82.0 (9.8) points in early adolescence, and 73.8 (11.5) points in late adolescence. Females (vs. males) exhibited slower rate of CVH score gain before the inflection point (0.3 vs. 1.0 points/y), later timing of inflection point when CVH score started declining (10.1 vs. 9.6y), and slower rate of CVH score decline after the inflection point (-1.3 vs. -1.5 points/y). Children of Black (β 0.48y; 95% CI 0.28, 0.68) or Other (β 0.28y; 95% CI 0.08, 0.49) race had a later timing of inflection point compared with White children. Children whose mothers were college-educated (vs. non-college educated) had higher CVH score throughout childhood, and exhibited faster rate of CVH score gain before the inflection point (β 0.19 points/y; 95% CI 0.03, 0.34), earlier timing of inflection point (β -0.37y; 95% CI -0.53, -0.22), and faster rate of CVH score decline after the inflection point (β -0.24 points/y; 95% CI -0.38, -0.10). No associations were observed for household income. Conclusions: This cohort study identified a key timepoint between mid-childhood and early adolescence where CVH trajectory declines over time, as well as sociodemographic differences in CVH trajectory parameters. Future studies are warranted to assess other determinants and consequences of these trajectory parameters.