Influential Periods in Longitudinal Clinical Cardiovascular Health Scores

The prevalence of ideal cardiovascular health (CVH) among adults in the United States is low, and decreases with age. Our objective was to identify specific age windows when the loss of CVH accelerates, to ascertain preventive opportunities for intervention. This study pools data from five longitudinal cohorts (Project Heartbeat!, Cardiovascular Risk in Young Finns Study, The Bogalusa Heart Study, Coronary Artery Risk Development in Young Adults (CARDIA), Special Turku Coronary Risk Factor Intervention Project (STRIP)) from the United States and Finland from 1973 to 2012. Individuals with clinical CVH factors (body mass index, blood pressure, cholesterol, blood glucose) measured between ages 8 to 55 were included. These factors were categorized and summed into a clinical CVH score ranging from 0 (worst) to 8 (best). Adjusted segmented linear mixed models were used to estimate the change in CVH over time. Among the 18,343 participants, 9461(52%) were female and 12,346(67%) White. The baseline mean (SD) clinical CVH score was 6.9(1.2) at an average age of 17.6(8.1). Two inflection points were estimated, at 16.9 years (95% CI: 16.4, 17.4) and at 37.2 years (95% CI: 32.4, 41.9). Late adolescence and early middle age appear to be influential periods at which the loss of CVH accelerates.