Associations of Blood Pressure and Cholesterol Levels During Young Adulthood With Later Cardiovascular Events

Abstract

Background: Blood pressure (BP) and cholesterol are major modifiable risk factors for cardiovascular disease (CVD), but effects of exposures during young adulthood on later life CVD risk have not been well quantified.

Objective: The authors sought to evaluate the independent associations between young adult exposures to risk factors and later life CVD risk, accounting for later life exposures.

Methods: The authors pooled data from 6 U.S. cohorts with observations spanning the life course from young adulthood to later life, and imputed risk factor trajectories for low-density lipoprotein (LDL) and high-density lipoprotein cholesterols, systolic and diastolic BP starting from age 18 years for every participant. Time-weighted average exposures to each risk factor during young (age 18 to 39 years) and later adulthood (age ≥40 years) were calculated and linked to subsequent risks of coronary heart disease (CHD), heart failure (HF), or stroke.

Results: A total of 36,030 participants were included. During a median follow-up of 17 years, there were 4,570 CHD, 5,119 HF, and 2,862 stroke events. When young and later adult risk factors were considered jointly in the model, young adult LDL ≥100 mg/dl (compared with <100 mg/dl) was associated with a 64% increased risk for CHD, independent of later adult exposures. Similarly, young adult SBP ≥130 mm Hg (compared with <120 mm Hg) was associated with a 37% increased risk for HF, and young adult DBP ≥80 mm Hg (compared with <80 mm Hg) was associated with a 21% increased risk.

Conclusions: Cumulative young adult exposures to elevated systolic BP, diastolic BP and LDL were associated with increased CVD risks in later life, independent of later adult exposures.

Keywords: blood pressure; cholesterol; coronary heart disease; heart failure; stroke; young adulthood.

FIGURE 1. Associations Between Young Adult and Later Adult Risk Factor Exposures and Incident CHD

TWA exposures to SBP, DBP, LDL, and HDL from young adulthood (18 to 39 years of age) and later adulthood (≥40 years of age) were included simultaneously in the same model. Models were stratified by study cohort and adjusted for race/ethnicity, sex, birth year, BMI, smoking status, cigarettes smoked per day, diabetes, years with diabetes, use of lipid-lowering and antihypertensive medications, and the early and later adult TWAs of other risk factors. Exposures to elevated DBP and LDL during young adulthood were associated with an increased risk of CHD, independent of later life exposures. BMI = body mass index; CHD = coronary heart disease; CI = confidence interval; DBP = diastolic blood pressure; HDL = high-density lipoprotein; HR = hazard ratio; LDL = low-density lipoprotein; SBP = systolic blood pressure; TWA = time-weighted average.

FIGURE 2. Associations Between Young Adult and Later Adult Risk Factor Exposures and Incident HF

TWA exposures to SBP, DBP, LDL, and HDL from young adulthood (18 to 39 years of age) and later adulthood (≥40 years of age) were included simultaneously in the same model. Model adjustments were the same as in Figure 1. Exposures to elevated SBP and DBP during young adulthood were associated with an increased risk of heart failure, independent of later life exposures. HF = heart failure; other abbreviations as in Figure 1.

FIGURE 3. Associations Between Young Adult and Later Adult Risk Factor Exposures and Incident Stroke

TWA exposures to SBP, DBP, LDL, and HDL from young adulthood (18 to 39 years of age) and later adulthood (≥40 years of age) were included simultaneously in the same model. Model adjustments were the same as in Figure 1. None of the young adult risk factors were independently associated with incident stroke, whereas later adult exposures to high SBP and DBP were strongly associated with stroke risk. Abbreviations as in Figure 1.

CENTRAL ILLUSTRATION. Associations of Blood Pressure and Cholesterol Levels During Young Adulthood With Cardiovascular Events Later in Life

Study of 36,030 U.S. adults found that exposures to elevated SBP, DBP, and LDL during young adulthood (18 to 39 years of age) were associated with increased CHD and heart failure risks in later life, independent of later adult exposures. BP = blood pressure; CHD = coronary heart disease; CI = confidence interval; DBP = diastolic blood pressure; HR = hazard ratio; LDL = low-density lipoprotein; SBP = systolic blood pressure; TWA = time-weighted average.