Substance use in adolescence is associated with future cardiovascular disease risk: findings from the national longitudinal study of adolescent to adult health

Background Substance use is a prevalent public health issue among adolescents in the United States (U.S.). While it’s a known risk factor for adult cardiovascular disease (CVD), the long-term impact of adolescent substance use on future CVD risk is understudied. This study aimed to (1) characterize substance use patterns in adolescents and (2) examine their association with future CVD risk. Methods We performed a secondary analysis using Waves I and IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health) dataset. All analyses accounted for the Add Health multistage sampling design using survey procedures in SAS. In Wave I, adolescent substance use was evaluated through three self-report measures: binge drinking, marijuana use, and cigarette smoking. Substance use was defined in two ways: first, as mutually exclusive patterns (e.g., smoking only, smoking + binge drinking), and second, by the total number of substances used (0–3) to examine dose–response relationships. CVD risk in adulthood was measured using the 30-year Framingham CVD risk score and categorized as low or high. Using multiple logistic regression, we examined the association between substance use and CVD risk in adulthood, while adjusting for covariates. Results The final analytic sample comprised 4,128 participants with an average age of 15 years at baseline. About 26% of adolescents reported binge drinking, and a similar percentage (26%) reported smoking, while 13% used marijuana. Compared with adolescents who reported no substance use, those using one substance had 1.82 times higher odds of CVD in adulthood (95% CI: 1.47–2.25) after controlling for covariates. The odds increased to 2.38 times for two substances (95% CI: 1.74–3.25) and to 2.68 times for three substances (95% CI: 1.98–3.61). Adolescents using multiple substances, like smoking and binge drinking or all three substances, had higher odds of adult CVD compared to non-users. Conclusion Substance use in adolescence is strongly associated with elevated CVD risk in adulthood. These findings underscore the need to include substance use prevention and early intervention within broader initiatives to lower the CVD burden. Addressing substance use in young people may thus be a vital opportunity to reduce long-term cardiometabolic risks.