Early cardiovascular risk assessment in young adults

Early cardiovascular risk assessment in young adults: what happened

A new study reports that artery damage can show up in adults in their 20s, underscoring the value of early cardiovascular risk assessment in young adults.

Independent research published today in Circulation: Population Health and Outcomes found that nearly 8 out of 10 participants (average age 23) had cardiovascular-kidney-metabolic syndrome (CKM syndrome). Participants with more advanced CKM stages showed early signs of arterial injury on carotid ultrasound imaging.

• Study population: 1,283 young adults in the Future of Families–Cardiovascular Health Among Young Adults (FF-CHAYA) cohort
• Key tools used: CKM syndrome staging and the American Heart Association’s Life’s Essential 8 cardiovascular health score
• Arterial measure: ultrasound imaging of the carotid arteries in the neck

What the evidence shows about early cardiovascular risk assessment in young adults

This evidence comes from analysis of health data in a diverse cohort of young adults, and it describes how risk profiles and early artery findings cluster together in people younger than 30.

Investigators assessed cardiovascular health in two ways—CKM stage and Life’s Essential 8 score—and checked for signs of arterial injury using carotid ultrasound. The report also notes that young adults with more advanced CKM syndrome stages had poorer Life’s Essential 8 scores.

• CKM prevalence: nearly 80% met criteria for CKM stages 1, 2, or 3
• Lower-risk group: about 21% had no identifiable CKM risk factors (Stage 0)
• Severe disease: none of the participants were in CKM stage 4

Why CKM syndrome changes the lens for early cardiovascular risk assessment in young adults

CKM syndrome is a staging framework that links obesity, diabetes, chronic kidney disease, and cardiovascular disease, which can help structure early cardiovascular risk assessment in young adults.

The study describes CKM stages from 0 (no risk factors) to 4 (existing cardiovascular conditions such as coronary heart disease, heart failure, or stroke). In this cohort, participants with more advanced CKM stages had early signs of arterial injury, which the researchers said supports starting prevention efforts earlier in life.

• CKM staging aims to reflect risk factor burden and disease status over time
• More advanced CKM stage aligned with both poorer Life’s Essential 8 scores and artery injury signs in this cohort

Practical context for metabolic health: using Life’s Essential 8 in your 20s

For many people in their 20s, conversations about prevention may center more on Life’s Essential 8 than long-term risk calculators, which is relevant when thinking about early cardiovascular risk assessment in young adults.

The report notes that American Heart Association/American College of Cardiology guidelines recommend the Predicting Risk of cardiovascular disease EVENTs (PREVENT) equations to estimate 10- and 30-year cardiovascular risk, but those equations were developed and validated for ages 30–79, so they were not applicable to this study’s participants. Dr. Donald Lloyd-Jones said discussions in this age group should focus on optimizing Life’s Essential 8 metrics for health now and over the long term.

• Life’s Essential 8 health behaviors: healthy eating, physical activity, avoiding tobacco, healthy sleep
• Life’s Essential 8 health factors: healthy weight, healthy cholesterol, healthy blood sugar, healthy blood pressure
• The study reports CKM staging and Life’s Essential 8 are complementary for identifying adults under 30 who may be on a faster track for arterial injury and plaque buildup, and ultimately at higher risk for future cardiovascular events (per Lloyd-Jones)

Limitations and what this study does (and doesn’t) prove

This study links CKM stage and cardiovascular health scores to early artery injury signs in young adults, but it does not establish that these findings will translate into future heart events for any one person.

The summary reports ultrasound evidence of arterial injury in relation to more advanced CKM stages, and it notes PREVENT risk equations were not applicable due to participant age. It also reports that none of the participants were in CKM stage 4, which limits what can be inferred about young adults who already have diagnosed cardiovascular disease.

• Population: young adults with an average age of 23; findings may not generalize to other ages
• Risk estimation tools: PREVENT equations were not applicable in this cohort because they are validated for ages 30–79
• Disease spectrum: no participants were in CKM stage 4