Maintaining and improving cardiovascular health throughout young adulthood was strongly associated with a lower risk of cardiovascular disease and all-cause mortality in midlife, according to new study cohort findings.

 

Data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, which followed 4,832 participants over multiple decades, was analyzed by researchers from the Northwester Feinberg School of Medicine. Unlike prior research based on single-point cardiovascular health (CVH) assessments, cumulative cardiovascular health from age 18 to 45 years using the American Heart Association’s Life’s Essential 8 (LE8) scoring system was used.

 

“Greater cumulative time at higher CVH during young adulthood, assessed by higher LE8 scores, correlates with lower subsequent risk of developing cardiovascular disease (CVD),” the authors wrote. “Adjusting for cumulative CVH, improvement in CVH during young adulthood was associated with significantly lower risk for developing CVD in midlife. Thus, change matters.”

 

 

Participants were stratified into quartiles based on their cumulative Life’s Essential 8 (LE8) scores from age 18 to 45 years, calculated as the area under the curve (AUC) in “point × years.” This novel metric integrates both the level and duration of cardiovascular health (CVH) over young adulthood. Compared with those in the lowest quartile (Q1, 0–25th percentile), participants in higher quartiles had significantly lower risk of cardiovascular disease (CVD) after age 45:

Corresponding reductions in all-cause mortality were also observed: Q2 (HR, 0.51), Q3 (HR, 0.38), and Q4 (HR, 0.29), each relative to Q1.

 

The mean cumulative LE8 scores by quartile were:

The average LE8 score at age 45 was lowest in Q1 (mean, 53.8) and highest in Q4 (mean, 82.3), reflecting the long-term impact of sustained cardiovascular health.

 

 

In addition to cumulative score, the slope of change in LE8 score during young adulthood—termed “points up”—was independently associated with incident CVD. Among participants with similar cumulative LE8 scores, those whose CVH improved over time had lower risk than those whose CVH declined.

 

“A positive slope of (improving) LE8 score from age 18 to 45 years [was] significantly associated with lower hazards for incident CVD after age 45 years,” the authors noted. In adjusted models, a positive slope was associated with a 35% lower risk of incident CVD (HR, 0.65; 95% CI, 0.45–0.95), independent of cumulative score.

 

 

Traditional cardiovascular health assessments rely on point-in-time measurements. This study introduced two novel metrics that integrate duration and direction of CVH during young adulthood, offering clinicians more precise tools for long-term risk stratification and patient communication.

These measurements may offer a more comprehensive picture of cardiovascular risk. For example, the researchers illustrated that “an increase from 0 to 90 minutes of moderate physical activity per week (13 minutes per day) over 20 years would be a 200–point × years increase”—a change associated with roughly 50% lower risk of developing CVD.

 

 

After adjusting for cumulative LE8 score, the study found no significant differences in CVD or mortality risk between Black and White participants (HR, 1.05; 95% CI, 0.81–1.35), suggesting that cumulative CVH may explain much of the disparity.

 

 

CARDIA is a community-based longitudinal study that enrolled 5,115 self-identified Black or White adults aged 18 to 30 years at 4 US centers beginning in 1985–1986. For this analysis, researchers included 4,832 participants with sufficient CVH and follow-up data and monitored CVD and mortality outcomes beginning at age 45 years.

 

The findings highlight the value of sustained cardiovascular health from early adulthood and suggest that both long-term consistency and improvement over time are independently protective. These results may support earlier implementation of preventive CVH interventions in clinical practice.