Introduction
Ideal cardiovascular health is present in <50% of children and <1% of adults, yet
its prevalence from adolescence through adulthood has not been fully evaluated. This
study characterizes the association of age with ideal cardiovascular health and compares
these associations across sex, race/ethnicity, and SES subgroups.
Methods
This study, conducted in 2020, analyzed adolescents and adults aged 12–79 years from
the cross-sectional National Health and Nutrition Examination Survey 2005–2016 (N=38,706).
Polynomial models were used to model the association of age with ideal cardiovascular
health, defined using the American Heart Association's Life's Simple 7 criteria (scales
0–14, with higher values indicating better cardiovascular health).
Results
Mean cardiovascular health was lower with increasing age, starting in early adolescence
and dropping to a nadir by age 60 years before stabilizing. At age 20 years, only
45% of adults had ideal cardiovascular health (≥5 ideal cardiovascular health metrics),
and >50% of adults had poor cardiovascular health (≤2 ideal cardiovascular health
metrics) at age 53 years. Women had higher mean cardiovascular health than men in
early life but lower mean cardiovascular health from age 60 years onward. Mean cardiovascular
health scores were highest for non-Hispanic White and higher-income adults and lowest
for non-Hispanic Black and low-income adults across all ages. Mean cardiovascular
health scores fell from intermediate to poor levels approximately 30 years earlier
for non-Hispanic Black than for non-Hispanic White adults and approximately 35 years
earlier for low-income adults than in higher-income adults.
Conclusions
Cardiovascular health scores are lower with increasing age from early adolescence
through adulthood. Race/ethnicity and income disparities in cardiovascular health
are observed at young ages and are more profound at older ages.
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REFERENCES
- Heart disease and stroke statistics-2017 update: a report from the American Heart Association [published correction appears in Circulation. 2017;135(10):e646] [published correction appears in Circulation. 2017;136(10):e196].Circulation. 2017; 135: e146-e603https://doi.org/10.1161/CIR.0000000000000485
- Status of cardiovascular health in U.S. adults: prevalence estimates from the National Health and Nutrition Examination Surveys (NHANES) 2003-2008.Circulation. 2012; 125: 45-56https://doi.org/10.1161/CIRCULATIONAHA.111.035733
- Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic impact goal through 2020 and beyond.Circulation. 2010; 121: 586-613https://doi.org/10.1161/CIRCULATIONAHA.109.192703
- Ideal cardiovascular health during adult life and cardiovascular structure and function among the elderly.Circulation. 2015; 132: 1979-1989https://doi.org/10.1161/CIRCULATIONAHA.115.017882
- Association of the duration of ideal cardiovascular health through adulthood with cardiometabolic outcomes and mortality in the Framingham Offspring Study.JAMA Cardiol. 2020; 5: 549-556https://doi.org/10.1001/jamacardio.2020.0109
- Cardiovascular health trajectories from childhood through middle age and their association with subclinical atherosclerosis.JAMA Cardiol. 2020; 5: 557-566https://doi.org/10.1001/jamacardio.2020.0140
- Association between ideal cardiovascular health score trajectories and arterial stiffness: the Kailuan Study.Hypertens Res. 2020; 43: 140-147https://doi.org/10.1038/s41440-019-0341-4
- Effect of secular trends on age-related trajectories of cardiovascular risk factors: the Whitehall II longitudinal study 1985-2009.Int J Epidemiol. 2014; 43: 866-877https://doi.org/10.1093/ije/dyt279
- Life course trajectories of cardiovascular risk factors in women with and without hypertensive disorders in first pregnancy: the HUNT study in Norway.J Am Heart Assoc. 2018; 7e009250https://doi.org/10.1161/JAHA.118.009250
- Temporal trends and familial clustering of ideal cardiovascular health in parents and offspring over the life course: an investigation using the Framingham Heart Study.J Am Heart Assoc. 2020; 9e016292https://doi.org/10.1161/JAHA.120.016292
- Trends in racial/ethnic disparities in cardiovascular health among U.S. adults from 1999-2012.J Am Heart Assoc. 2017; 6e006027https://doi.org/10.1161/JAHA.117.006027
- Association between cumulative social risk and ideal cardiovascular health in U.S. adults: NHANES 1999-2006.Int J Cardiol. 2015; 191: 296-300https://doi.org/10.1016/j.ijcard.2015.05.007
- Health insurance status as a barrier to ideal cardiovascular health for U.S. adults: data from the National Health and Nutrition Examination Survey (NHANES).PLoS One. 2015; 10e0141534https://doi.org/10.1371/journal.pone.0141534
- Sex and ethnicity modify the associations between individual and contextual socioeconomic indicators and ideal cardiovascular health: MESA study.J Public Health (Oxf). 2019; 41: e237-e244https://doi.org/10.1093/pubmed/fdy145
National Health and Nutrition Examination Survey. National Center for Health Statistics, Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/nhanes/index.htm. Updated December 31, 2021. Accessed April 9, 2020.
- The Healthy Eating Index: design and applications.J Am Diet Assoc. 1995; 95: 1103-1108https://doi.org/10.1016/S0002-8223(95)00300-2
- The Healthy Eating Index-2010 is a valid and reliable measure of diet quality according to the 2010 Dietary Guidelines for Americans.J Nutr. 2014; 144: 399-407https://doi.org/10.3945/jn.113.183079
- National Health and Nutrition Examination Survey: laboratory procedures manual.National Centers for Disease Statistics, Centers for Disease Control and Prevention, Atlanta, GA2011 (Accessed April 15, 2020)
- National Health and Nutritional Examination Survey: analytic guidelines 1999-2010.Vital Health Stat. 2013; 2: 1-24https://www.cdc.gov/nchs/data/series/sr_02/sr02_161.pdfDate accessed: April 15, 2020
- Prevention of cardiovascular diseases: role of exercise, dietary interventions, obesity and smoking cessation.Exp Clin Cardiol. 2005; 10: 229-249
- Association of trajectory of cardiovascular health score and incident cardiovascular disease.JAMA Netw Open. 2019; 2e194758https://doi.org/10.1001/jamanetworkopen.2019.4758
- Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee [published correction appears in Circulation. 2006;114(23):e629] [published correction appears in Circulation. 2006;114(1):e27].Circulation. 2006; 114: 82-96https://doi.org/10.1161/CIRCULATIONAHA.106.176158
- Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults: a scientific statement from the American Heart Association.Circulation. 2010; 122: 406-441https://doi.org/10.1161/CIR.0b013e3181e8edf1
- Our future: a Lancet commission on adolescent health and wellbeing.Lancet. 2016; 387: 2423-2478https://doi.org/10.1016/S0140-6736(16)00579-1
- Patterns and correlates of physical activity and nutrition behaviors in adolescents.Am J Prev Med. 2007; 32: 124-130https://doi.org/10.1016/j.amepre.2006.10.012
- Healthy weight and cardiovascular health promotion interventions for adolescent and young adult males of color: a systematic review.Am J Mens Health. 2018; 12: 1328-1351https://doi.org/10.1177/1557988318777923
- A systematic review of eHealth behavioral interventions targeting smoking, nutrition, alcohol, physical activity and/or obesity for young adults.Prev Med. 2017; 99: 197-206https://doi.org/10.1016/j.ypmed.2017.01.009
- A systematic review of SNAPO (Smoking, Nutrition, Alcohol, Physical activity and Obesity) randomized controlled trials in young adult men.Prev Med. 2015; 81: 221-231https://doi.org/10.1016/j.ypmed.2015.09.005
- Efficacy of exercise intervention for weight loss in overweight and obese adolescents: meta-analysis and implications.Sports Med. 2016; 46: 1737-1751https://doi.org/10.1007/s40279-016-0537-6
- Dietary and lifestyle interventions for weight management in adults from minority ethnic/non-White groups: a systematic review.Obes Rev. 2010; 11: 769-776https://doi.org/10.1111/j.1467-789X.2009.00695.x
- A meta-analysis of obesity interventions among U.S. minority children.J Adolesc Health. 2010; 46: 309-323https://doi.org/10.1016/j.jadohealth.2009.11.202
- Influence of age and menopause on serum lipids and lipoproteins in healthy women.Atherosclerosis. 1993; 98: 83-90https://doi.org/10.1016/0021-9150(93)90225-j
- Weight gain in women at midlife: a concise review of the pathophysiology and strategies for management.Mayo Clin Proc. 2017; 92: 1552-1558https://doi.org/10.1016/j.mayocp.2017.08.004
- Menopause-related blood pressure increase and its relationship to age and body mass index: the SIMONA epidemiological study.J Hypertens. 2005; 23: 2269-2276https://doi.org/10.1097/01.hjh.0000194118.35098.43
- Heart disease and stroke statistics - 2016 update: a report from the American Heart Association [published correction appears in Circulation. 2016;133(15):e599].Circulation. 2016; 133: e38-e360https://doi.org/10.1161/CIR.0000000000000350
- Hypertension awareness, treatment, and control in U.S. adults: trends in the hypertension control cascade by population subgroup (National Health and Nutrition Examination Survey, 1999-2016).Am J Epidemiol. 2019; 188: 2165-2174https://doi.org/10.1093/aje/kwz177
- Hypertension prevalence and control among adults: United States, 2015‒2016.NCHS Data Brief. 2017; : 1-8https://www.cdc.gov/nchs/data/databriefs/db289.pdfDate accessed: July 1, 2021
- Factors associated with hypertension control in U.S. adults using 2017 ACC/AHA Guidelines: National Health and Nutrition Examination Survey 1999-2016.Am J Hypertens. 2018; 31: 886-894https://doi.org/10.1093/ajh/hpy047
- Prevalence of diabetes by race and ethnicity in the United States, 2011-2016.JAMA. 2019; 322: 2389-2398https://doi.org/10.1001/jama.2019.19365
- Racial disparities in hypertension prevalence, awareness, and management.Arch Intern Med. 2005; 165: 2098-2104https://doi.org/10.1001/archinte.165.18.2098
- Time course studies of blood pressure in children–the Bogalusa Heart Study.Am J Epidemiol. 1979; 109: 320-334https://doi.org/10.1093/oxfordjournals.aje.a112685
- Trends in blood pressure among children and adolescents.JAMA. 2004; 291: 2107-2113https://doi.org/10.1001/jama.291.17.2107
- Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009.JAMA. 2014; 311: 1778-1786https://doi.org/10.1001/jama.2014.3201
- Traditional risk factors as the underlying cause of racial disparities in stroke: lessons from the half-full (empty?) glass.Stroke. 2011; 42: 3369-3375https://doi.org/10.1161/STROKEAHA.111.625277
- Income disparities and cardiovascular risk factors among adolescents [published correction appears in Pediatrics. 2019;143(2):e20183644].Pediatrics. 2018; 142e20181089https://doi.org/10.1542/peds.2018-1089
- Early emerging nicotine dependence symptoms in adolescence predict daily smoking in young adulthood.Drug Alcohol Depend. 2015; 151: 267-271https://doi.org/10.1016/j.drugalcdep.2015.03.009
- Population tobacco control interventions and their effects on social inequalities in smoking: systematic review.Tob Control. 2008; 17: 230-237https://doi.org/10.1136/tc.2007.023911
- Impact of tobacco control interventions on socioeconomic inequalities in smoking: review of the evidence.Tob Control. 2014; 23: e89-e97https://doi.org/10.1136/tobaccocontrol-2013-051110
- Where the U.S. tobacco epidemic still rages: most remaining smokers have lower socioeconomic status.J Health Care Poor Underserved. 2017; 28: 100-107https://doi.org/10.1353/hpu.2017.0012
- Inequalities persist despite decline in poverty for all major race and Hispanic origin groups.U.S. Census Bureau, Suitland-Silver Hill, MD2020
- Diet quality – what is it and does it matter?.Public Health Nutr. 2009; 12: 2473-2492https://doi.org/10.1017/S136898000900531X
- Indices of diet quality.Curr Opin Clin Nutr Metab Care. 2008; 11: 559-565https://doi.org/10.1097/MCO.0b013e32830a49db
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Published online: January 07, 2022
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© 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
