Abstract 10: Cumulative Ideal Cardiovascular Health During Young Adulthood and Premature Cardiovascular Events in Midlife

Introduction: Data are lacking on the association between long-term cumulative achievement of ideal cardiovascular health (CVH) during young adulthood and midlife cardiovascular disease (CVD) events. We hypothesized that higher cumulative ideal CVH score during young adulthood is associated with lower risk of CVD events in midlife. Methods: We studied 230 959 participants of the Korean National Health Insurance health screening at index age 40 years without prior CVD. All participants underwent ≥3 (median, 7) health examinations, including Y0 at age 30, Y10 at age 40, and ≥1 visit in between. We defined a 10-year cumulative CVH score, calculated as the area under CVH score plotted against age from 30 to 40 years, based on the AHA’s “Life’s Simple 7” metric excluding diet (score 0-12 at each visit; cumulative score 0-120 over 10 years; Figure A). The primary outcome was composite CVD events, including myocardial infarction, stroke, heart failure, and CVD-related death. Results: During a median follow-up of 9.6 years after index age 40 years, 2180 CVD events occurred. Participants with higher cumulative CVH score before age 40 years had lower cumulative incidence of CVD events over the next decade (Figure B). After multivariable adjustment, each year lived with 1-point higher CVH score from age 30 to 40 years was associated with 3.5% lower hazard of CVD events after age 40 years (Figure C). Each 1-point higher CVH score maintained for 10 years was associated with 30% lower hazard of CVD events. The associations remained significant even when adjusted for midlife CVH (single-visit CVH score at index age 40 years). When stratified by midlife CVH, higher cumulative CVH score during young adulthood was associated with lower hazard of subsequent CVD events, irrespective of midlife CVH (Figure D). Conclusions: Cumulative attainment of ideal CVH during young adulthood, independently of midlife CVH, was associated with lower risk of premature CVD events in midlife, highlighting the importance of maintaining ideal CVH from an earlier age.