The Coronary Artery Risk Development In Young Adults (CARDIA) Study: JACC Focus Seminar 8/8

Abstract

The CARDIA (Coronary Artery Risk Development in Young Adults) study began in 1985 to 1986 with enrollment of 5,115 Black or White men and women ages 18 to 30 years from 4 US communities. Over 35 years, CARDIA has contributed fundamentally to our understanding of the contemporary epidemiology and life course of cardiovascular health and disease, as well as pulmonary, renal, neurological, and other manifestations of aging. CARDIA has established associations between the neighborhood environment and the evolution of lifestyle behaviors with biological risk factors, subclinical disease, and early clinical events. CARDIA has also identified the nature and major determinants of Black-White differences in the development of cardiovascular risk. CARDIA will continue to be a unique resource for understanding determinants, mechanisms, and outcomes of cardiovascular health and disease across the life course, leveraging ongoing pan-omics work from genomics to metabolomics that will define mechanistic pathways involved in cardiometabolic aging.

Keywords: cardiovascular disease; cardiovascular health; cardiovascular risk factors; race; social determinants of health.

Figure 1.. Numbers of participants attending each CARDIA examination cycle.

CARDIA participants have undergone in-person examinations at baseline (Year 0) and follow up Years 2, 5, 7, 10, 15, 20, 25, and 30. Retention rates among surviving participants at each in-person examination were 91%, 86%, 81%, 79%, 74%, 72%, 72%, and 71%, respectively.

Figure 2.. Incidence rates of cardiovascular disease and all-cause mortality in the CARDIA cohort.

Contact is maintained with CARDIA participants via telephone, mail, or email every 6 months, with annual interim medical history ascertainment. Over the last 5 years, >90% of the surviving cohort members have been directly contacted, and follow up for vital status is virtually complete through related contacts and intermittent National Death Index searches. The figure shows incident event rates from 1985 through February, 2021 for cardiovascular disease (light blue columns) and total mortality (dark blue columns) by sex and race groups.

Figure 3.. Blood pressure trajectories across young adulthood and coronary artery calcification.

Mid-blood pressure (mean of systolic and diastolic blood pressure) was recorded at each CARDIA exam and participants were clustered using latent mixture modeling. Five unique groups were identified based on trajectory patterns across 25 years. Groups with blood pressure trajectories that were elevated at baseline with subsequent stable or increasing values, and those with moderate levels at baseline and increasing trajectory, had significantly higher odds of presence of coronary artery calcification at the Year 25 examination. Adapted with permission from reference .

Figure 4.. Changes in cholesterol levels by time and type of menopause.

Concentrations of high-density (HDL) and low-density (LDL) lipoprotein cholesterol were measured over time in women in the CARDIA cohort and compared before and after onset of menopause (Time 0), according to the type of menopause: surgical hysterectomy with bilateral oophorectomy (dash-dot line), surgical hysterectomy only (dashed line), or natural (solid line). Women with natural menopause had greater increases in LDL-cholesterol after menopause, and in HDL-cholesterol before menopause. Adapted with permission from reference .

Figure 5.. Heart failure incidence by race and sex groups.

By 20 years’ follow up in the CARDIA cohort (ages 18-30 at baseline), there were 27 cases of incident heart failure. Strikingly, of the 27 participants affected, 26 self-identified as being Black. Among Black participants, baseline variables significantly associated with incident heart failure included higher diastolic blood pressure and body mass index, lower high-density lipoprotein cholesterol, and presence of kidney disease. Three-fourths of those in whom heart failure developed had hypertension by the time they were 40 years of age. From reference with permission.

Figure 6.. Cardiovascular disease incidence by cardiovascular health (CVH) status at baseline.

Cardiovascular health status at ages 18-30 years was assessed and defined as high (12-14 points), moderate (8-11 points), or low (0-7 points) based on levels of 7 health behaviors and factors. After 30 years’ follow up, cardiovascular event rates were very low in those with high CVH at baseline, and significantly higher for those with moderate or poor CVH, overall and by demographic subgroups. From reference .

Figure 7.. Trends in body mass index (BMI) by race and sex over 30 years.

BMI (weight in kilograms divided by the square of height in meters) has increased steadily from baseline (Year 0; 1985-86) to the most recent exams in CARDIA. Rates of increase in BMI have been similar across race/sex groups.

Central Illustration.. CARDIA and the Life Course of Cardiovascular Health

Schematic of the Coronary Artery Risk Development in Young Adults study (CARDIA) and its contributions to understanding the life course of cardiovascular health and disease. CVD = cardiovascular disease.