Heart Health
Even modest improvements to diet, sleep, and exercise in young adulthood can dramatically lower the odds of later cardiovascular disease
Your chances of having a heart attack in your 20s—even in your 30s or 40s—are pretty slim; the average age for this life-threatening medical emergency is around 65 for men and over 70 for women. For young adults, cardiovascular disease (CVD) is such a distant threat that most probably don’t ever think about it. But a new Boston University–led study suggests that making minor lifestyle changes early in life can have an outsized, lifelong impact on heart health, significantly reducing your chances of CVD in your golden years.
The researchers found that those with unfavorable patterns of heart health in young adulthood faced a much higher risk of cardiovascular disease by middle age, while those who improved even a few habits saw meaningful, long-term benefits. The findings were published in JAMA Network Open.
The BU team examined 40 years of data from the National Heart, Lung, and Blood Institute–funded Coronary Artery Risk Development in Young Adults (CARDIA) study, a decades-long project that has followed the ongoing health of thousands of adults who were all aged between 18 and 30 in the mid-1980s.
To track how heart health scores shifted over time, the researchers used the American Heart Association’s Life’s Essential 8 (LE8) scoring system, which measures a person’s diet, physical activity, nicotine exposure, sleep, weight, blood pressure, blood sugar, and blood lipids. A higher LE8 score indicates a healthier lifestyle—and better cardiovascular health. The researchers observed how those scores changed over participants’ first 20 years in the study, and then how those patterns related to poor outcomes, such as heart attacks and strokes, in the subsequent 20 years.
CVD remains the leading cause of death in the United States and worldwide. The Brink spoke with Donald Lloyd-Jones, a BU Chobanian & Avedisian School of Medicine professor of medicine and director of the BU-led Framingham Heart Study, about what the research uncovered and what steps young adults can take now to protect their long-term health.
Q&A
With Donald Lloyd-Jones
The Brink: How did this study come about, and why focus specifically on young adults?
Lloyd-Jones: Most previous work looked at LE8 scores at a single point in time. We wanted to know whether a change in LE8 during young adulthood predicts long-term outcomes. CARDIA provided four decades of data, which allowed us to watch how scores evolved and connect those patterns to real health events. Young adults often do not feel at risk for heart disease because the consequences seem far in the future. LE8 allows people to measure their cardiovascular health in the present, and it highlights areas where they can take meaningful action.
The Brink: What were the main findings?
Lloyd-Jones: We identified four heart health trajectories during young adulthood. These patterns were strongly tied to later outcomes. People who maintained high LE8 scores from ages 18 to 30 had the lowest risk for heart attacks and strokes, while those who remained at moderate levels had about twice the risk. Participants whose scores declined from moderate to low had a tenfold higher risk of cardiovascular events in midlife. Even small improvements in LE8 during early adulthood were linked to better outcomes than staying stable or declining. Any improvement, even modest, can reduce future risk.
The Brink: Were the findings surprising?
Lloyd-Jones: We expected that declines in heart health would lead to poorer outcomes, but the size of the difference was striking. The tenfold higher risk was a powerful signal. At the same time, it was encouraging to see how much impact even small positive changes can have.
The Brink: For readers unfamiliar with LE8, why is it important?
Lloyd-Jones: Many people wait until they have high blood pressure, elevated cholesterol, or diabetes before taking action. By that point, the opportunity to prevent disease has already narrowed. There is a cost to the years spent with rising levels. LE8 measures cardiovascular health across the full spectrum of behaviors and biological factors. It shows your current status and offers concrete steps you can take to maintain or improve your health before disease begins. This makes it an exceptionally useful tool for prevention.
The Brink: Are some of these eight components more important for young adults than others?
Lloyd-Jones: Older adults at high risk should focus on quitting smoking and controlling blood pressure. Young adults, however, have more time. Almost any behavior they choose to improve will have a positive impact on the rest. Improving diet helps sleep, physical activity, weight, blood pressure, and blood sugar. Improving sleep has similar ripple effects. I encourage young adults to begin with whatever they are most motivated to change.
The Brink: Can even small improvements make a real difference?
Lloyd-Jones: Yes. Roughly 10 percent of participants increased their LE8 scores between ages 18 and 30. They had significantly better outcomes than peers whose scores stayed flat or declined. You can improve your cardiovascular health at any age, but the benefit is larger when you start earlier.
The Brink: What advice would you give to young adults who want to improve their heart health now?
Lloyd-Jones: First, any improvement will help, and starting earlier increases the impact. Second, measure your numbers. You cannot know your blood pressure, cholesterol, or blood sugar without checking. It is also important to remember that your generation will eventually become parents. Healthier adults tend to have healthier children, and that creates a positive cycle across generations.
The Brink: How does this study connect to your broader research?
Lloyd-Jones: Our earlier work focused on cardiovascular health in middle-aged adults. Then we moved upstream into young adulthood. Now we are looking at heart health in childhood and even prenatal influences. We are studying how cardiovascular health is transmitted across generations. Intervening early in life provides the greatest opportunity to shift long-term outcomes.
The Brink: What motivates you to study cardiovascular prevention early in life?
Lloyd-Jones: I have seen the impact of cardiovascular disease later in life. We can manage and delay it, but we cannot cure it. The encouraging fact is that a large majority of heart attacks are preventable or postponable with what we already know. As someone with children in their twenties, I also see how much more aware this generation is about health. They have the chance to change the future burden of disease in ways that were not possible before.
Gina DiGravio contributed reporting to this article.