Cardiovascular Health in Young Adults Has Not Improved Over the Past Decade

According to a new study published in the American Journal of Preventative Cardiology,  only 1 in 4 adults aged 18-44 years old have ideal cardiovascular health, as per the American Heart Association (AHA) Life’s Essential 8 (LE8) score.

AHA Life’s Essential 8 Checklist 

The LE8 checklist offers key measures for individuals to improve and maintain their cardiovascular health, as defined by guidelines from the AHA. The checklist focuses on 8 areas, covering both health behaviors and health factors:

1. Eat better
2. Be more active
3. Quit tobacco
4. Get healthy sleep
5. Manage weight
6. Control cholesterol
7. Manage blood sugar
8. Manage blood pressure

Each component is graded on a scale of 0-100, and the mean value of the 8 components is considered the individual’s LE8 score. For the study by Naman S. Shetty and colleagues, an “ideal” LE8 score was defined as >80. Intermediate scores were those between 50-79, and poor scores were those <50.

Life’s Simple 7 

In addition to examining the LE8 scores in this population, the researchers compared how these scores aligned with the Life’s Simple 7 (LS7), an earlier version of the LE8 framework. The LS7 measures 7 components: physical activity, blood glucose, blood lipids, blood pressure, smoking, body mass index (BMI), and diet. Each component is graded as 0 (poor), 1 (intermediate), or 2 (ideal), and the sum of the components is the total LS7 score.

The investigators evaluated whether the updated LE8 framework would impact the cardiovascular health ratings in this population.

Heart Health in Young Adults

Dr. Shetty and colleagues, from the University of Alabama at Birmingham, sought to evaluate cardiovascular health among young adults without a history of cardiovascular disease using data from the National Health and Nutrition Examination Survey (NHNES). Data from 12,197 individuals who completed the NHNES from 2007-2018 were included in the analysis. Three groups were created depending on the year of NHNES data: 2007-2010, 2011-2014, and 2015-2018.

Population Demographics

Regarding demographics in the study population, roughly half of the participants were male (n=6115) and the average age was 30.6 years. Fifty-nine percent of the population were non-Hispanic White, 11.8% were non-Hispanic Black, 12.2% were Mexican American, and the remaining participants (16.6%) were classified as “Other.”

Three-quarters of the patients were insured. Thirty-one percent of individuals had a Family Poverty Income Ratio of <1.3, indicating an income under the poverty line.

Trends in Heart Health Scores 

The investigators reported that cardiovascular health scores were “stable” over the study period, with no overall improvement from 2007-2018. Overall, the mean LE8 score 69.2 (standard deviation =0.3). The highest-scoring individual component was blood sugar, with a mean of 91.2; the lowest-scoring component was diet (35.7). Regarding trends in individual components, sleep component scores increased over time, while blood pressure, blood glucose, and BMI scores decreased.

There was a strong correlation found between LS7 and LE8 scores (P<.001) and a moderate agreement between the classification of poor/intermediate/ideal cardiovascular health (P<.001). When assessing the NHNES population at large, the researchers found that 5.9% of individuals who were classified as “poor” according to the LS7 would have been reclassified as “intermediate” on the LE8. Of those individuals classified as “intermediate” by the LS7, 17.6% were reclassified as “poor” according to the LE8 and 5% were reclassified as “ideal.” Notably, 47% of individuals with “ideal” health on the LS7 would be reclassified into the “intermediate” group on the LE8, and 0.2% would be reclassified into the “poor” category.

“About 20 million individuals with LS7-defined ideal cardiovascular health were reclassified as intermediate or poor cardiovascular health by the LE8 score,” the authors wrote. “These individuals represent a previously unidentified section of the population who would benefit from primary preventative interventions.”

Impact of Sex on Cardiovascular Outcomes 

Females scored higher than males in all components except BMI and physical activity. The authors noted that physical activity score improved in females over the course of the study period. In males, blood sugar, blood pressure, and BMI scores decreased over time. Females also had decreases in blood sugar and BMI scores. Sleep improved over time for both sexes.

Differences in healthcare utilization and preventative care may explain some of the distinctions between sexes. “Females in early adulthood are more likely to seek help and follow up more frequently with a physician compared with males which may explain the higher scores [for males] in the blood pressure, blood lipids, and blood glucose categories,” the authors wrote.

Worse Cardiovascular Health Scores in Black Patients 

Notably, Black individuals had the lowest overall LE8 scores than any other race/ethnicity group analyzed. The mean LE8 for non-Hispanic Black individuals was 65.1, compared with 69.9 for White individuals, 67.3 for Mexican Americans, and 71.2 for participants in the “Other” group. The subgroup of Black adults also scored lower than other race/ethnicity subgroups in the blood pressure, blood sugar, and diet categories. There was a decrease in blood lipid scores over time for Black adults; LE8 scores in all other components were stable over time.

Social determinants of health, such as socioeconomic factors, education level, and geographic residence, “may largely explain the lower scores observed in Non-Hispanic Black individuals,” the authors noted. “Black individuals are more likely to have lower socioeconomic status and attain lower education levels compared with Non-Hispanic White individuals. Furthermore, Non-Hispanic Black individuals are more likely to reside in poorer neighborhoods and lack transportation which may limit their access to healthy food and healthcare.”

In summary, the authors wrote, “Among US young adults, there has been no improvement in cardiovascular health over the last decade, with notable sex and race/ethnicity-associated differences in the LE8 score.” For clinicians, they added that use of the LE8 score “can help identify the specific categories which require improvement and therefore plan a directed intervention to improve cardiovascular health.”

Reference:

Shetty NS, Parcha V, Patel N, et al. AHA Life’s essential 8 and ideal cardiovascular health among young adults. Am J Prev Cardiol. 2022 Dec 23;13:100452. doi:10.1016/j.ajpc.2022.100452.