Abstract 195: Associations of Cardiovascular Health During Late Adolescence and Young Adulthood With Incident Premature Cardiovascular Events and Mortality: The Coronary Risk Development in Young Adults Study (CARDIA)

Abstract

Introduction: Mid-life cardiovascular health (CVH) is strongly associated with risks of later-life CVD and mortality across race and sex groups. Adolescent and young-adult CVH are associated with risk of subclinical CVD, but data are lacking regarding CVD events or mortality. Hypotheses: (1) CVH in late adolescence/young adulthood (18-30y) is associated with risks of premature CVD and mortality; (2) Event rates are uniformly low across sociodemographic subgroups with high baseline CVH. Methods: CVH (defined by AHA’s 7 metrics) was measured at baseline and total CVH scores were categorized as high (12-14 pts), moderate (8-11) or low (0-7). CVD events and cause-specific mortality were adjudicated over 32y of follow-up. We estimated adjusted associations of baseline CVH with outcomes using Cox models and calculated population attributable fractions (PAFs; adjusted for competing risk of death as applicable) and event rates by CVH category. Results: See Table . Among 4836 participants, mean age was 24.9y (SD 3.6), 44.1% were aged 18-24y, 54.8% were female, and 50.5% were black. Baseline CVH was high in 28.8%, moderate in 65.0%, and low in 6.3%. In total, 306 CVD events and 431 deaths occurred. CVH was significantly associated with all outcomes, with similar patterns by age, sex, and race. PAFs for moderate/low (vs high) CVH ranged from 0.42 (all-cause mortality) to 0.63 (CVD) to 0.81 (CVD mortality) overall; PAFs were not significantly different across sociodemographic subgroups. Among individuals with high CVH, event rates were low across all sociodemographic subgroups (e.g., CVD rates/1000 person-yrs: age 18-24y 0.64, 25-30y 0.65, women 0.36, men 1.04, black 0.90, white 0.50). Conclusions: High CVH at age 18-30y was associated with low rates of premature CVD and mortality. Preservation of high CVH to at least age 18y may reduce CVD and mortality burdens and disparities, and adolescent/young-adult CVH may be a valid intermediate outcome for early-life determinants of risk.