Prioritizing Heart Health in Young Adults Could Have Substantial Impact on Rates of Premature Cardiovascular Events

Research from the Yonsei University College of Medicine in South Korea is underlining the importance of prioritizing cardiovascular health during young adulthood as a way to reduce risk of premature cardiovascular disease in midlife.

An analysis of data from more than 3.5 million patients with a median follow-up of 16.1 years, results demonstrate associations between lower cardiovascular health scores in young adulthood were linked to increased risk of cardiovascular events in midlife, but also suggested these scores could be improved to reduce risk.

"Most people lose ideal cardiovascular health before they reach midlife, yet few young people have immediate health concerns and many do not usually seek medical care until approaching midlife," said senior investigator Hyeon Chang Kim, MD, PhD, Professor in the Department of Preventive Medicine at Yonsei University College of Medicine, in a statement from the American Heart Association. "We need strategies to help preserve or restore heart health in this population because we know poor heart health in young adults is linked to premature cardiovascular disease."

To learn more about how declines in cardiovascular health during young adulthood might influence risk of premature cardiovascular and mortality, Kim and a team of colleagues designed their study as an analysis of data from the Korean National Health Insurance Service, which is a nationwide, single-provider database. Using data from adults who complete routine health exams in 2003-2004, investigators identified 3,565,189 participants for potential inclusion in their analyses.

For the purpose of analysis, investigators classified patients according to ideal cardiovascular health scores, which were calculated as the number of nondietary ideal components met from the American Heart Association’s Life Simple 7 metrics. The primary outcome of interest for their analyses was a composite cardiovascular disease event defined as first hospitalization for myocardial infarction, stroke, or heart failure, or cardiovascular death by December 31, 2019, which was the end of the follow-up period.

The 3,565,189-patient cohort had a median age of 31 years and 65.6% were male. Among this patient population, approximately 13% had a baseline cardiovascular health score of 1 or less, 25.6% had a score of 3, and just 1.4% had a score of 6. After exclusion of those with incomplete information, previous cardiovascular disease, or less than 1 year of follow-up, a group of 3,325,420 were included in the final analyses.

During a median follow-up period of 16.1 years, a total of 39,165 incident cardiovascular disease events occurred. Investigators pointed out all these events occurred at the age of 55 or younger and were considered premature.

Results of their analyses indicated the cumulative incidence of events was greatest for those with a baseline score of 0, with an incidence rate of 0.23% per year compared to a rate of less than 0.02% per year among those with a score of 6. In adjusted analyses, those with scores of 1, 2, 3, 4, 5, and 6, respectively were at 26%, 49%, 65%, 75%, 82%, and 85% lower risk for the primary outcome compared to those with a baseline score of 0.

Further analysis of a subgroup of 2,881,115 patients with data from health examinations in 2003-2004 and 2005-2008 indicated an increase in cardiovascular health score was associated with a lower risk of the primary outcome (HR, 0.79; 95% CI, 0.78-0.80, per each 1-point increase in score). Investigators went on to highlight that these patients were still at an increased risk of cardiovascular events when compared to those with maintained higher scores at baseline and subsequent follow-up visits.

Investigators cautioned the findings of their study may be limited by the design. Specifically, reliance on a population of Korean ancestry and limitations associated with use of routine health screening data.

This study, “Associations of Ideal Cardiovascular Health and Its Change During Young Adulthood with Premature Cardiovascular Events: A Nationwide Cohort Study,” was published in Circulation.