In the U.S. and many high-income countries, premature cardiovascular disease is on the rise. There is a strong association between early-life cardiovascular health and premature cardiovascular disease events, highlighting the need for regular monitoring of cardiovascular health through young adulthood and beyond, according to a research letter published in Circulation.

Hokyou Lee, MD, et al., used the Korean National Health Insurance Service database to evaluate routine health examination data of young adults aged 20 to 39 from 2003 to 2004. The researchers categorized participants by their optimal cardiovascular health scores, calculated as the number of nondietary ideal cardiovascular health components met (0-6). A composite cardiovascular disease event was the primary endpoint. Researchers defined this variable as first hospitalization for myocardial infarction (MI), heart failure (HF), stroke or cardiovascular death by December 2019. They used the Cox proportional hazards model to measure the multivariable-adjusted hazard ratios linked to cardiovascular health score.

Among the 3,565,189 participants included in the study, 65.6% were male and the median age was 31. Results showed that during a median follow-up period of 16.1 years, 39,165 first cardiovascular disease events were recorded. These events occurred at 55 years or younger and were considered premature.

Participants with a baseline cardiovascular health score of 0 had a higher cumulative incidence rate for cardiovascular disease events. For participants with a cardiovascular health score of 6, the incidence rate for cardiovascular disease events was less than 0.02% annually. Compared to baseline cardiovascular health scores of 0, participants with a score of 1 had a 26% lower hazard rate for cardiovascular events. Similarly, participants with scores of 2 had a 49% lower hazard rate, scores of 3 had a 65% lower hazard rate, and scores of 4 had a 75% lower hazard rate.

For every 1-point increase in cardiovascular health score, participants had a lower risk for MI, HF, stroke and cardiovascular death. Even if a participant's score increased at the follow-up period, their low baseline scores would put them at greater risk for cardiovascular disease events than participants with high initial cardiovascular health scores.

"[Our] findings add some grounds for optimism that regaining lost [cardiovascular health] during young adulthood may still improve future [cardiovascular disease] risk," write the authors. "[Our] findings also demonstrate that young adults with poor [cardiovascular health] remain at higher risk even after improving their [cardiovascular health] compared with those who retained ideal [cardiovascular health] in the first place."

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: ACC International, Cardiovascular Diseases, Heart Failure, Myocardial Infarction, Stroke, Hospitalization

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