Elevated blood pressure and cholesterol levels in young adulthood may lead to an increased risk of heart disease later in life, regardless of later in life exposure to these risk factors, according to research published July 15 in the Journal of the American College of Cardiology.

Yiyi Zhang, PhD, et al., used data from six large, community-based, prospective cohort studies to estimate the independent associations of risk factor exposures during young adulthood (age 18-39 years) and later adulthood (age ≥40 years) with subsequent risk of coronary heart disease, heart failure and stroke. The researchers calculated period-specific time-weighted averages of systolic blood pressure (SBP), diastolic blood pressure (DBP), and high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol exposure levels for younger and older adults.

A total of 36,030 participants were included in the analysis. Over a follow-up period of 17 years, there were 4,570 incident coronary heart disease (CHD) events, 5,119 heart failure events and 2,862 stroke events. Average measurements of SBP, DBP, LDL and HDL from young adulthood were all strongly correlated with later in life averages. Elevated LDL during young adulthood was associated with a 64 percent increased risk of coronary heart disease, independent of later life exposures. High SBP and DBP in young adulthood were independently associated with a 37 percent and 21 percent increased risk of heart failure, respectively. While no young adult exposures were independently associated with stroke, increased levels of high later life SBP or DBP were strong predictors of stroke.

According to the researchers, young adults are difficult to reach with traditional, clinic-based preventive programs. They recommend implementation of preventive programs targeting individual young adults that are web-based, patient-centered, mobile and account for the fact that this age group may discount the importance of their future heart disease risk.

In a related editorial comment, Samuel S. Gidding, MD, FACC, and Jennifer Robinson, MD, MPH, explain that this study should be a wake-up call for the medical community to recognize the preventive care gaps experienced by younger adults.

“The time has come to recognize that preventive interventions are occurring too late in life to have a substantial impact on the population burden of atherosclerotic cardiovascular disease (ASCVD) and heart failure,” they said. “Interventions in those with established ASCVD, advanced subclinical atherosclerosis, impaired myocardial function, diabetes or renal insufficiency are disease treatment studies and not true prevention. By moving to trials in younger higher risk individuals who have less advanced disease more amenable to reversal and developing precision medicine strategies based on genetics, imaging and other risk factors, the next era of cardiovascular disease prevention can begin.”

Keywords: Young Adult, Blood Pressure, Risk Factors, Cholesterol, LDL, Prospective Studies, Follow-Up Studies, Hypertension, Heart Failure, Coronary Disease, Heart Diseases, Atherosclerosis, Renal Insufficiency, Diabetes Mellitus, Stroke, Lipoproteins, HDL, Preventive Health Services

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