Lifestyle-Based Tool Estimates Premature Cardiovascular Disease in Young Patients

The Healthy Heart Score (HHS) is an effective tool for identifying the risks of atherosclerotic cardiovascular disease (ASCVD) and can assist in determining counseling for primary prevention. A study, recently published by JAMA, evaluated the performance of the lifestyle-based tool, the HHS, which estimates the risk of early ASCVD events in young adults.

The study included 4893 US adults between the ages of 18 and 30 years from the Coronary Artery Risk Development in Young Adults (CARDIA) study. These patients had participated in lifestyle factor measurements from March 25, 1985, through June 7, 1986, and were followed up approximately 27.1 years later.

The HHS was calculated through the consideration of age, smoking status, body mass index (BMI), amount of exercise, alcohol consumption, and diet. A higher overall HHS indicated a greater risk for ASCVD in the study.

At the 27.1 year follow up, 69 ASCVD events occurred in 64 of the women, with 31 being coronary heart disease events and ischemic stroke making up 38 of the events. There were 104 total ASCVD events among 99 men—75 experiencing coronary heart disease events and 29 experiencing ischemic stroke events. These events occurred at 45.9 years old, on average, and most participants showed no signs of clinical ASCVD risk factors during the original examination.

The study emphasized that those who experienced ASCVD events had unhealthier levels of all HHS variables during young adulthood, on average. The HHS was determined to have performed moderately well at estimating the 25-year risk for early ASCVD events.

“Young adulthood is a time of significant change, and improvements in health behaviors during this period have been shown to reduce the likelihood of having intermediate markers of atherosclerosis in the CARDIA28 and other longitudinal cohorts,” the authors wrote.

The HHS is noted to be a strong indicator because of its reliance on lifestyle factors that can be self-reported. A physician can have a patient complete the HHS, which can help lead discussion on how to modify behavior to improve cardiovascular health in efforts to prevent ASCVD. The researchers acknowledged the minimal awareness and attention of cardiovascular risks among young people and expressed hope that the HHS can be used to change that.

“Whether and how a risk estimation tool such as the HHS can be used to motivate young persons to seek regular primary care and lower their risk for ASCVD through behavior change remains an area for future research,” the authors concluded.