Artery damage in adults in their 20s highlights need for early cardiovascular risk assessment

A new study found that nearly 8 out of 10 young adult participants, with an average age of 23 years, had cardiovascular-kidney-metabolic syndrome (CKM syndrome), according to independent research published today in Circulation: Population Health and Outcomes.

Participants with more advanced CKM syndrome had early signs of arterial injury, the researchers reported, highlighting the urgent need for cardiovascular disease prevention efforts to begin earlier in life.

Investigators assessed participants’ cardiovascular health status in two ways: determining their CKM syndrome stage and their Life’s Essential 8 cardiovascular health score. They checked for signs of arterial injury with ultrasound imaging of the carotid arteries (large arteries in the neck that carry blood to the brain).

“The study shows that CKM syndrome staging and Life’s Essential 8 are complementary for identifying adults younger than age 30 who may be on the fast track for arterial injury, plaque buildup and, ultimately, at higher risk for future cardiovascular events,” said Dr. Donald Lloyd-Jones, an American Heart Association volunteer who is a cardiologist at Boston Medical Center, professor of medicine at Boston University’s Chobanian & Avedisian School of Medicine, director of the Framingham Center for Population and Prevention Science, and principal investigator of the Framingham Heart Study.

CKM syndrome describes the interconnected relationship among obesity, diabetes, chronic kidney disease and cardiovascular disease. CKM syndrome is categorized by stages that reflect a person’s risk factors, ranging from 0 (no risk factors) to 4 (existing cardiovascular conditions such as coronary heart disease, heart failure or stroke).

The American Heart Association’s Life’s Essential 8 comprises two major areas, health behaviors and health factors, that provide a framework for measuring, monitoring and improving cardiovascular health.

Measuring and monitoring cardiovascular health in your 20s

American Heart Association/American College of Cardiology guidelines for preventing and managing high blood pressure, high cholesterol and CKM syndrome recommend clinicians use the Predicting Risk of cardiovascular disease EVENTs (PREVENT) equations to estimate a person’s 10- and 30-year risk of cardiovascular disease. However, those equations were developed and validated for use in people ages 30–79. Because of the young age of participants in this study, the PREVENT equations are not applicable, Lloyd-Jones said.

“In my practice, and what I would recommend, is that the conversation focuses on Life’s Essential 8 and optimizing as many of those metrics as possible for better health today and in the long term,” said Lloyd-Jones, who is also a former volunteer president of the American Heart Association.

The health behaviors and health factors in Life’s Essential 8 are:

• healthy eating
• physical activity
• avoiding tobacco
• healthy sleep
• healthy weight
• healthy cholesterol
• healthy blood sugar
• healthy blood pressure

“For people in their 20s, we want to focus on improving cardiovascular health,” Lloyd-Jones said. He explained that the Life’s Essential 8 framework is designed “for measuring, monitoring and improving cardiovascular health at any age, but especially in adolescents and young adults” and has been linked to their health now and in the long term.

Lloyd-Jones added that these everyday health measures help people understand how lifestyle choices influence heart, kidney and metabolic health over time and provide practical steps to improve overall health.

Study details

Scientists analyzed health data from 1,283 participants in the Future of Families–Cardiovascular Health Among Young Adults (FF-CHAYA) study, a diverse cohort of adults with an average age of 23 years, and found:

• Nearly 80% of participants met criteria for CKM syndrome stage 1, 2 or 3, meaning they already had excess adiposity, metabolic risk factors and/or evidence of subclinical cardiovascular disease. About 21% had no identifiable CKM risk factors (Stage 0). None were in stage 4.
• Young adults with more advanced CKM syndrome stages had poorer Life’s Essential 8 scores.
• More advanced CKM syndrome stages were associated with early arterial injury, including thicker carotid artery walls, an early marker of atherosclerosis, even among people in their early 20s.

Researchers concluded that the findings highlight the urgent need for prevention efforts to begin earlier in life, suggesting there are opportunities to improve cardiovascular health and prevent disease progression long before cardiovascular disease becomes clinically apparent.

Study limitations

The study has several limitations, including its cross-sectional design, which shows association but cannot establish cause and effect; multiple outcomes were evaluated simultaneously; and some health behavior data were self-reported. In addition, because the study population intentionally included many individuals from disadvantaged backgrounds, the findings may not be generalizable to all young adults. Researchers said additional long-term studies are needed to determine how CKM syndrome stage in young adulthood relates to future cardiovascular disease risk.

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Gaby Clark

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Robert Egan

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