Young Adults Who Lost And Then Restored Heart Health Had Lower Risk Of Heart Attack, Stroke

Preserving good cardiovascular health during young adulthood is one of the best ways to reduce risks of premature heart attack or stroke, according to new research published today in the American Heart Association’s flagship journal Circulation.

The number of premature deaths from cardiovascular disease is increasing in many countries including the U.S. While there is a wealth of information available on maintaining good heart health during and after midlife to reduce the risks of heart attack and stroke, data about cardiovascular health during young adulthood is scarce.

“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,” says the study’s senior author Hyeon Chang Kim, M.D., Ph.D., a professor in the department of preventive medicine at Yonsei University College of Medicine in Seoul, South Korea. “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.”

Using the Korean National Health Insurance Services, a nationwide health insurer database, Kim and colleagues analyzed information collected from more than 3.5 million adults who completed routine health exams in 2003 and 2004. A subgroup of approximately 2.9 million participants underwent a follow-up health examination between 2005 and 2008. Patients’ ages ranged from 20 to 39 at the time of the first exam, and 65.5% of the study participants were male.

Participants were categorized according to ideal cardiovascular health (CVH) scores based on the American Heart Association’s Life’s Simple 7® metrics. Patients received “one point” towards a cardiovascular health (CVH) score for each of the following measures from Life’s Simple 7: well-maintained blood pressure, low total cholesterol, acceptable blood sugar levels, an active lifestyle, healthy weight and not smoking. Of note: healthy nutrition and diet, the final measure of Life’s Simple 7, was not included in this analysis because dietary information was not collected from participants in this database.  

Researchers evaluated the total number of first hospitalizations or death from a heart attack, stroke or heart failure by December 31, 2019 to define outcomes. The researchers found:

• Rates of premature (younger than 55) cardiovascular events were highest among patients with a CVH score of zero.
• A higher CVH score by one point led to reduced risks for heart attack by 42%, heart failure by 30%, cardiovascular death by 25% and stroke by 24%.
• While people who improved their CVH score over time reduced their risk of hospitalizations or death from a heart attack, stroke or heart failure, people who began with and maintained a higher CVH score ultimately had the least chance of hospitalization or death from a heart attack or stroke during the study period.
• Timely and consistent monitoring of heart health among young adults is important to prevent premature onset of heart disease and reduce the risk of cardiovascular events.

The study’s findings may be limited because data was routine health screening data, therefore, it may not be as robust as data collected primarily for a specific study. The study also lacks data on the participants’ eating patterns, so researchers modified CVH score metrics to exclude diet. In addition, participants in this study were of Korean ancestry, so the results may not be generalizable to people from other diverse racial or ethnic groups.

Co-authors are Hokyou Lee, M.D.; Yuichiro Yano, M.D., Ph.D.; So Mi Jemma Cho, Ph.D.; Hyeok-Hee Lee, M.D.; Dong-Wook Kim, Ph.D.; and Donald M. Lloyd-Jones, M.D., Sc.M. Author disclosures are listed in the manuscript.

The study was partially supported by a grant from the Korea Health Technology R&D Project through the Korean Health Industry Development Institute and funded by the Ministry of Health and Welfare of the Republic of Korea.