Patterns of cardiovascular health during young adulthood strongly predict the risk of heart disease, stroke, and death decades later, according to a new study led in part by Harvard-affiliated Beth Israel Deaconess Medical Center.

Using data from the long-running Coronary Artery Risk Development in Young Adults study, which has followed more than 5,000 adults across the U.S. over the past 35 years, researchers found that individuals whose cardiovascular health declined between their 20s and 40s were up to ten times more likely to develop heart disease by their 60s than those who maintained or improved their heart health. The study’s results are published in JAMA Network Open.

“In short, our study suggests that change matters: Improvements in cardiovascular health can decrease future heart disease risk and the earlier good habits and heart health are obtained and maintained, the better,” said lead author James Guo, a resident physician of internal medicine at BIDMC and a clinical fellow at Harvard Medical School.

Investigators assessed participants’ heart health using the American Heart Association’s Life’s Essential 8 (LE8), a measure that combines eight key factors known to support and define cardiovascular well-being (diet, physical activity, sleep, body mass index, blood cholesterol, blood sugar, blood pressure, and avoiding tobacco exposure) into a single score ranging from 0 to 100. A higher score reflects better cardiovascular health.

The team identified four distinct longitudinal trajectories of cardiovascular health that tracked cardiovascular health measured by LE8 through the participants’ young adulthood, between their 20s to 40s: persistently high, persistently moderate, moderately declining, and moderate-to-low declining. While all four patterns showed decline in cardiovascular health, some trajectories demonstrated steeper declines than others.

Compared with those maintaining persistently optimal heart health, individuals with poorer cardiovascular health trajectories during young adulthood faced significantly higher risks — ranging from two to ten times greater — of developing cardiovascular disease later in life, including heart attacks, strokes, heart failure, the need for coronary revascularization, and cardiovascular-related death. Even modest declines in LE8 scores were consequential: for every 10-point drop out of 100 points between participants’ 20s and 40s, the risk of developing cardiovascular disease later in life increased by 53 percent.

Young adulthood is a time of transitions: finishing school, starting careers, forming families, and navigating changes in healthcare. It is also a period when heart health often fluctuates. This makes the early years of adulthood an ideal window for what researchers call primordial prevention, building and sustaining healthy behaviors before heart disease risk factors like high blood pressure or diabetes appear.

“These findings highlight a broader public health message: Investing in risk factor prevention through health promotion during young adulthood can yield lifelong benefits, reducing the overall burden of heart disease for future generations,” said Guo. “I believe strongly in the adage attributed to Benjamin Franklin, that an ounce of prevention is worth a pound of cure. Cardiovascular disease prevention starts with cardiovascular health promotion in early life.”

This study was supported in part by the American Heart Association and the National Heart, Lung, and Blood Institute.