Results:

A total of 9,388 participants were included, mean age 17.5 years at baseline, 55% were female, and 6,228 were white. Groups with higher CV health during childhood were more likely to be female and have more favorable levels of CV risk factors. Five trajectory patterns were identified: a) high-late decline (1,518 participants [16%]), b) high-moderate decline (2,403 [26%]), c) high-early decline (3,066 [32%]), d) intermediate-late decline (1,475 [16%]), and e) intermediate-early decline (926 [10%]). Groups that started at intermediate levels and/or experienced rapid declines were less likely to have an ideal diet or meet guidelines for the recommended amount of physical activity at baseline. Individuals in the high-late decline clinical CV health group had higher maternal and paternal educational levels. The high-late decline group had significantly lower adjusted cIMT versus other trajectory groups (high-late decline: 0.64 mm [95% CI, 0.63-0.65 mm] vs. intermediate-early decline: 0.72 mm [95% CI, 0.69-0.75 mm] when adjusted for demographics and baseline smoking, diet, and physical activity; p < 0.01). The intermediate-early declining group had higher odds of high cIMT (odds ratio, 2.4; 95% CI, 1.3-4.5) compared with the high-late decline group, even after adjustment for baseline or proximal CV health score.