Cardiovascular health decline in adolescent girls in the NGHS cohort, 1987-1997

Abstract

Adolescence is a critical time for the preservation or loss of cardiovascular health. We aimed to describe trajectories of cardiovascular health in adolescent girls and identify early adolescent factors associated with cardiovascular health in young adulthood. We used data from the National Growth and Health Study, a longitudinal cohort of 2,379 girls followed annually from ages 9-19 years. We classified participants as having ideal, intermediate, or poor levels of the seven cardiovascular health metrics at four developmental stages: early (ages 9-11), middle (ages 12-14), and late (ages 15-17) adolescence, and early young adulthood (ages ≥ 18). We calculated total cardiovascular health scores (range 0-14) at each stage and empirically identified patterns of cardiovascular health trajectories. We examined associations between trajectory group membership and various demographic, behavioral, and physiological factors. Mean cardiovascular health scores declined with age from 10.8 to 9.4 in white girls and 10.3 to 8.9 in black girls; 17% of white girls and 23% of black girls had low cardiovascular health (score < 8) by early young adulthood. We identified five cardiovascular health trajectories: high-stable (14% of participants), high-to-moderate (48%), high-to-low (20%), moderate-stable (10%), and moderate-to-low (8%). Exceeding 14 h per week of television in early adolescence and teen pregnancy were associated with higher odds of being in several less healthy trajectory groups. In conclusion, cardiovascular health declines during adolescence and black-white disparities begin before early adolescence. Key targets for improving cardiovascular health in adolescent girls may include reductions in sedentary behavior and prevention of teen pregnancy.

Keywords: AHA, American Heart Association; BMI, body mass index; CVD, cardiovascular disease; CVH, cardiovascular health; Cardiovascular disease; HEI, Health Eating Index; MET, metabolic equivalent; NGHS, National Growth and Health Study; Pediatrics; Risk factors; Women.

Fig. 1

Total Cardiovascular Health (CVH) Score in Girls enrolled in the National Growth and Health Study, 1987–1997. Total CVH score (0–14) reflects the summation of scores on the seven individual cardiovascular health metrics for each participant during each developmental period.

Fig. 2

Empirically-derived Trajectories of the Cardiovascular Health Score over 10 years for Adolescent Girls in the National Growth and Health Study, 1987–1997. Five trajectory classes identified and labeled.