- New research shows that building heart-healthy habits during young adulthood (and earlier) may determine your risk of heart disease decades later.
- In a 40-year study of more than 4,200 young adults, those with better heart health early on maintained it — while others saw a steady decline.
- The findings suggest early prevention is key, but even later lifestyle changes can still help protect against heart attack and stroke.
Building healthy heart habits early in life is essential to lowering your risk of heart attack and stroke in later adulthood.
You’ve likely heard this advice before from a doctor or loved one. But new research shows just how closely heart health in early adulthood is linked to the risk of developing cardiovascular disease later in life.
In a study published on October 6 in JAMA Network Open, researchers followed more than 4,200 participants between the ages of 18 and 30 for nearly 40 years to track long-term trends. They found that participants tended to follow distinct heart health trajectories. And those patterns began early: By age 25, most had already settled into consistent habits that supported heart health — or didn’t.
Researchers used Life’s Essential 8, a composite scoring system developed by the American Heart Association (AHA), to assess overall cardiovascular health. It includes health behaviors such as smoking status and sleep quality, as well as health indicators like blood pressure and cholesterol levels.
Individuals who have a high LE8 score are assessed as having good cardiovascular health, while low scores are linked to poor cardiovascular health.
People who had good cardiovascular health early in adulthood, indicated by high LE8 scores, tended to maintain it as they aged. Meanwhile, those with unfavorable cardiovascular health and low LE8 scores saw their habits and health decline over time.
Those patterns had real-world effects on health outcomes: poor cardiovascular health in early adulthood was linked to a tenfold increase in the risk of cardiovascular disease later in life.
“The original purpose of the study was to understand how we go from healthy young adults to middle-aged folks who develop risk factors,” said Donald M. Lloyd-Jones, MD, cardiologist and cardiovascular epidemiologist at Boston University, and senior author of the study.
“What we found was that if you had a high score, you tended to maintain that high score. And the worse you were at the start, the more it tended to decline over time. People with the persistently high LE8 score had the fewest cardiac events by far,” Lloyd-Jones told Healthline.
Heart-healthy habits lower heart attack risk later in life
Researchers examined the link between heart health in young adulthood and later cardiovascular disease using the Coronary Artery Risk Development in Young Adults (CARDIA) study, a long-term prospective study.
Starting in 1985–1986, participants underwent regular exams to track factors that contribute to cardiovascular disease over the next 35 years.
Lloyd-Jones and his team included 4,241 participants in the study. More than half (55.5%) were female, and nearly half (48%) self-identified as Black. The remainder were white males.
Cardiovascular health was assessed using the Life’s Essential 8 score and used to track heart health changes throughout adulthood.
Participants fell into 4 distinct trajectory patterns of heart health over time:
- Persistent high — started with a high score and maintained it
- Persistent moderate — started with a middle score and maintained it
- Moderate declining — started with a middle score that got worse
- Moderate/low declining — started with a moderate to low score that got worse
Researchers identified several important conclusions from these trajectories. The first was that the four trajectory patterns never converged with one another, indicating that once someone was on a given path, for better or worse, they stayed on it.
“This study suggests that the cardiovascular health trajectory that is established by age 25 years is difficult to change going forward. So early education and intervention are necessary,” said Eiman Jahangir, MD, MPH, director of general cardiology and cardio oncology at Vanderbilt University Medical Center. He wasn’t involved in the study.
The second conclusion was how much risk was associated with each group. Compared to the “persistent high” scoring cohort, each group experienced a higher incidence of cardiovascular events in a stepwise fashion: the worse the trajectory, the greater the risk.
People in the least favorable trajectory, those with low declining scores, had a ten times higher risk of CVD later in life compared to the high-scoring group.
Interestingly, individuals whose cardiovascular health changed over time — someone who started with a poor score and improved it, or a high score that got worse — had no statistically significant difference than those in the middle-scoring group.
“There may be residual effects of lower cardiovascular health status that carries through to adulthood,” said Jahangir. “Building healthy habits early in life is very important because it may be difficult to catch up in the future. Meaning correcting for those early poor habits later in life may not be enough, and that your risk may remain higher.”
Heart health matters at every age
The findings underscore the importance of building heart-healthy habits during young adulthood and even earlier. You are “never too young” to start thinking about heart health, said Lloyd-Jones.
“Putting our children onto those healthier trajectories means they’re more likely to stay at the top of that group with highest cardiovascular health across their life course. Those people will live longer and with less chronic diseases. I think that’s a real win,” he said.
However, he emphasized that heart health matters at every age. While starting early offers the greatest benefit, the research shows that improving your habits later in life can still lower your risk of cardiovascular disease.
Anyone can use Life’s Essential 8 to understand the key factors that shape heart health and take steps to improve it — such as being more physically active or getting better sleep.
“It is never too late to change. Yes, the earlier you start, the bigger the impact will be, but it will always help, it will always improve your outcomes,” Lloyd-Jones said.
Jahangir recommends speaking with your healthcare provider to determine what the most effective course of action will be for your individual circumstance.
“Primary prevention remains our number one tool for fighting heart disease. This includes annual check-ups with a primary care doctor to check blood pressure, checking cholesterol as indicated, and counseling on diet, exercise, and tobacco cessation,” he said.
