YI 1.2 Ideal Cardiovascular Health Score Declines from Adolescence to Emerging Adulthood
Authors: Park Chloe , Jones Siana , Williams Suzanne , Rapala Alicja , Taylor Hannah , Howe Laura , Fraser Abigail , Chaturvedi Nish , Hughes Alun 
Published: December 2020

Abstract
Purpose
To define and compare cardiovascular (CV) health scores (CHS) from adolescence (17 yrs) to emerging adulthood (24 yrs) using longitudinal data from a large British birth cohort.

Methods
3142 participants from the Avon Longitudinal Study of Parents and Children (ALSPAC) study attended clinical investigations at 17.8 ± 0.4 yrs and 24.0 ± 0.8 yrs (38% male). CV health was assessed using smoking status, body mass index (BMI), plasma glucose, cholesterol, sitting brachial blood pressure, left ventricle (LV) hypertrophy, arterial stiffness (carotid-to-femoral pulse wave velocity) and atherosclerosis (carotid intima-media thickness) metrics. Prevalence was stratified into poor (0_points), intermediate (1_point) and ideal (2_points) health categories and a composite, individual-level CHS for all 8 metrics was calculated (total range, 0–16 points). Prevalence of ideal health was assessed using ANOVA and linear mixed modelling assessed age##sex modifications.

Results
Overall CHS was high at 17 yrs but from 17–24 yrs the proportion of ideal scores decreased for all metrics, in both sexes (Table). The average overall CHS decreased from 14.97 ± 1.1 to 13.99 ± 1.4 in males (p < 0.0001) and 14.82 ± 1.2 to 14.28 ± 1.4 in females (p < 0.0001, age##sex p = 0.0001). Significant sex differences were observed in the proportion of individuals with ideal health at both ages, with males having a higher CHS than females at 17 yrs but a lower CHS at 24 yrs.

Conclusions
Despite being relatively early in the life-course, CV health declines from 17 yrs to 24 yrs in both sexes, and more substantially in males. Emerging adulthood is a distinct period of lifestyle change and an important time to control CV risk factors to improve future CV health.

Table

Male

0
1

Age

17 yrs

24 yrs

Age0
Age1
Age2
Age3
Age4

Score
0
1
2
0
1
2
p
0
Score0
Score1
Score2
Score3
Score4

Smoking
22.6
19.3
58.1
27.8
35.6
36.6
<0.0001
27.8
Smoking0
Smoking1
Smoking2
Smoking3
Smoking4

BMI
4.9
13.3
82.1
10.4
30.0
59.6
<0.0001
6.7
BMI0
BMI1
BMI2
BMI3
BMI4

Glucose
0.4
9.1
90.5
0.6
34.7
64.7
<0.0001
0.3
Glucose0
Glucose1
Glucose2
Glucose3
Glucose4

Cholesterol
0.0
1.5
98.5
2.1
11.7
86.2
<0.0001
0.1
Cholesterol0
Cholesterol1
Cholesterol2
Cholesterol3
Cholesterol4

Blood pressure
0.2
0.5
99.3
0.6
5.4
94.0
<0.0002
0.3
Blood pressure0
Blood pressure1
Blood pressure2
Blood pressure3
Blood pressure4

LV hypertrophy
0.6
0.6
98.9
1.4
3.7
94.8
<0.0001
0.5
LV hypertrophy0
LV hypertrophy1
LV hypertrophy2
LV hypertrophy3
LV hypertrophy4

Arterial stiffness
0.5
0.9
98.6
4.8
6.7
88.5
<0.0001
0.0
Arterial stiffness0
Arterial stiffness1
Arterial stiffness2
Arterial stiffness3
Arterial stiffness4

Atherosclerosis
0.0
0.9
99.1
0.0
1.2
98.8
0.0005
0.0
Atherosclerosis0
Atherosclerosis1
Atherosclerosis2
Atherosclerosis3
Atherosclerosis4

Average CHS

14.97 ± 1.1

13.99 ± 1.4
<0.0001

14.82 ± 1.2

Average CHS0
Average CHS1
Average CHS2
Average CHS3
Average CHS4

Data are % of participants in each category for each risk factor. 0 = poor, 1 = intermediate and 2 = ideal. Age##sex p value for modification.