Associations of Late Adolescent or Young Adult Cardiovascular Health With Premature Cardiovascular Disease and Mortality

Background: When measured in adolescence or young adulthood, cardiovascular health (CVH) is associated with future subclinical CVD, but data are lacking regarding CVD events or mortality. Objectives: We examined associations of CVH at age 18–30 years with premature CVD and mortality. Methods: We analyzed data from the Coronary Artery Risk Development in Young Adults study. CVH was scored at baseline (1985–1986) using Life’s Simple 7 metrics and categorized as high (12–14 points), moderate (8–11) or low (0–7). CVD events and cause-specific mortality were adjudicated over 32 years’ follow-up. We estimated adjusted associations using Cox models and calculated event rates and population attributable fractions (PAFs) 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 HRs (95% CI) for high (vs low) CVH were 0.14 (0.09–0.22) for CVD and 0.07 (0.03–0.19) for CVD mortality, and the PAFs for moderate/low (vs high) CVH were 0.63 (0.47–0.74) for CVD and 0.81 (0.55–0.92) for CVD mortality. Among individuals with high CVH, event rates were low across sociodemographic subgroups (e.g., CVD rates/1000 person-years: age 18–24, 0.64; age 25–30, 0.65; men, 1.04; women, 0.36; Blacks, 0.90; Whites, 0.50; ≤high-school education, 1.00; >high-school, 0.61). Conclusions: High CVH in late adolescence/young adulthood was associated with very low rates of premature CVD and mortality over 32 years, indicating the critical importance of maintaining high CVH. Condensed abstract: We investigated associations of cardiovascular health (CVH), based on Life’s Simple 7, at age 18–30 years with premature CVD and mortality over 32 years. Among 4,836 participants, baseline CVH was high (favorable) in 29%, moderate in 65%, and low in 6%. The adjusted HR for CVD was 0.14 (95% CI, 0.09–0.22) for high (vs low) CVH, and the population attributable fraction for moderate/low (vs high) CVH was 0.63 (0.47–0.74). Among individuals with high CVH, CVD rates were low across subgroups defined by age, sex, race, and education, indicating the potential impact of maintaining high CVH throughout childhood into young adulthood. Summary Tweet: Favorable cardiovascular health in adolescence or young adulthood was associated with very low rates of premature CVD and mortality over 32 years. Twitter handle for Senior Author: @dmljmd