Cardiovascular health in US adolescents: far from ideal.

Amajor component of the American Heart Association’s (AHA) Strategic Impact Goal through 2020 and beyond is the promotion of ideal cardiovascular health across the life course. Central to this AHA goal are data indicating that individuals who maintain optimal levels of established risk factors for cardiovascular disease (CVD) through adult life have dramatically lower lifetime CVD risk and markedly longer survival than do their adult counterparts who developed 1 or more risk factors earlier in life. Additional recent evidence from the Cardiovascular Risk in Young Finns Study, an ongoing population-based prospective study, indicates that the presence of adverse levels of risk factors for CVD during adolescence strongly influences adult risk for CVD. Taken together with 4 decades of clinical and epidemiologic evidence that documents the impact of risk factors and adverse health behaviors on cardiovascular structure and function beginning early in life, these results underscore the importance of primordial prevention and lifelong ideal cardiovascular health. The AHA’s operational definition of ideal cardiovascular health is stratified by age (children, adults) and includes 4 health behaviors (current smoking, body mass index, physical activity, and healthy diet) and 3 health factors (total cholesterol, blood pressure, and fasting plasma glucose). Recognizing the importance of ideal cardiovascular health in adolescence and in the absence of nationally representative prevalence estimates, Shay and colleagues examined its components in 4673 participants aged 12 to 19 years from the 2005Y2010 National Health and Nutrition Examination Surveys (NHANES). Of note, to ensure the nationally representative nature of sampling, NHANES data are collected with the use of a complex, multistage probability design to select participants from strata defined by geography and proportion of minority populations. The analytic sample for this prevalence study represented approximately 33.2 million US adolescents. Population prevalence of individual cardiovascular health behaviors and factors was estimated using AHA criteria for ideal, intermediate, and poor levels. For children and youth, ideal (by health behavior and health factor) was operationally defined as follows: smoking status, never tried; body mass index, less than 85th percentile for age and sex; physical activity, 60 minutes or more of moderate or vigorous intensity activity every day; healthy diet, adherence to 4 to 5 components of Healthy Diet Score; total cholesterol level less than 170 mg/dL; blood pressure less than 90th percentile for age and sex; and fasting plasma glucose level less than 100 mg/dL. Results indicated that ideal blood pressure was most prevalent (males, 78%; females, 90%); in contrast, a dramatically low prevalence of ideal Healthy Diet Score was observed (males,G1%; females,G1%). Females exhibited a lower prevalence of ideal total cholesterol (65% vs 72%, respectively) and physical activity (44% vs 67%, respectively) levels; however, females had a higher prevalence of ideal blood glucose level (89% vs74%, respectively) compared with male counterparts. Of note, approximately two-thirds of adolescents (males, 66%; females, 67%) exhibited ideal body mass index, ascertained by direct measurement