Cardiovascular Health in Youth Linked to Lower Disease Risk in Adulthood

An analysis of results from the Coronary Artery Risk Development in Young Adults (CARDIA) study has indicated that both cardiovascular health (CVH) improvement in young adults and better cardiovascular health in middle age were independently associated with lower midlife risk of cardiovascular disease (CVD).1

Investigators utilized Life’s Essential 8 (LE8), an updated version of the quantitative metric for monitoring and measuring CVH created by the American Heart Association (AHA) in 2010. The original consisted of seven core features: healthy diet, participation in physical activity, nicotine avoidance, healthy weight, and healthy blood pressure, blood lipids, and blood glucose. The eighth factor, healthy sleep, was added in 2022.2

“Most literature on the association between cardiovascular health (CVH) and incident cardiovascular disease (CVD) and mortality has relied on single midlife measurements,” wrote James Walker, BA, department of preventative medicine, Northwestern University Feinberg School of Medicine, and colleagues. “Understanding how cumulative CVH over time influences later-life CVD and mortality may aid early prevention.”1

The CARDIA study, a longitudinal, community-based cohort study that ran from 1985-2020, involved 5115 participants between 18-30 years. Walker and colleagues quantified CVH from these data according to the AHA’s LE8 score, with each measure scored on a scale of 0-100 points. Overall LE8 score was calculated as the unweighted mean of all 8 metrics.1

Investigators established a primary outcome of CVD incident through 2022, with a secondary outcome of all-cause mortality. 45 years was marked as the start of outcome follow-up time. Of the original 5115 participants, 4832 had the necessary follow-up data for inclusion in the study – those who had experienced CVD events or died before age 45 were also excluded.1

Participants were divided into 4 quartiles based on cumulative LE8 score: the team assessed the relationship between LE8 scores before and after age 45 using multivariable Cox proportional hazards regression models. Outcomes were fitted into the quartile model as a categorical variable (percent by quartile: 0-25th [lowest], >25th-50th, >50th-75th, and >75th-100th) and as a continuous variable (per 20 points higher LE8 point x years). A model was fitted with the covariates of cumulative LE8 score and a single LE8 score measure at 45 years to assess the relationship between them.1

The 4832 included CARDIA participants, of which 2690 (55.7%) were female, had a mean cumulative LE8 score from 18-45 years of 2018.8 (95.0) point x years. The difference between mean Q1 and Q4 cumulative LE8 scores was marked as 626 point x years. Q4 participants exhibited the most favorable CVH health metric levels, including BMI, blood pressure, blood lipid levels, nicotine exposure, serum glucose value, etc.) followed sequentially by Q3, 2, and 1.1

Investigators also noted that, during the 14.2 years of follow-up, 285 CVD deaths and 323 deaths from all causes occurred. Participants with the highest quartile of cumulative LE8 score had the least mortality and CVD events during follow-up; each lower quartile exhibited a higher risk of developing mortality or CVD.1

Compared with the lowest quartile, 2, 3, and 4 all had significantly lower hazard ratios (HRs) for CVD (Q2 HR, 0.44; 95% CI, .32-.61; Q3 HR, .26; 95% CI, .18-38; Q4 HR, .12; 95% CI, .07-.21) and mortality (Q2 HR, .51; 95% CI, .36-.71; Q3 HR, .38; 95% CI, .26-.55; Q4 HR, .29; 95% CI, .18-.45) after age 45. Cumulative and improvement of LE8 scores from 18-45 years also associated significantly with lower CVD risk.1

The team notes that these data indicate a greater cumulative time at higher CVH during young adulthood correlates with lower risk of CVD development in later years.

“Point x years and points up could be useful ways to communicate and promote CVH to young adult patients,” Walker and colleagues wrote. “Given the recent promising research on harnessing gamification to encourage patients to change their health behaviors, further research could examine the potential for using point x years and points up in the LE8 paradigm to improve young adult CVH.”1

References

• Walker J, Won D, Guo J, et al. Cumulative Life’s Essential 8 Scores and Cardiovascular Disease Risk. JAMA Cardiol. Published online April 23, 2025. doi:10.1001/jamacardio.2025.0630

• Lloyd-Jones DM, Allen NB, Anderson CAM, et al. Life’s essential 8: Updating and enhancing the American Heart Association’s construct of Cardiovascular Health: A presidential advisory from the American Heart Association. Circulation. 2022;146(5). doi:10.1161/cir.0000000000001078