Let’s break down what the researchers found.
Reviewed by Dietitian Casey Wing, RD, CD
Key Points
- Chronic disease begins developing years before an actual diagnosis.
- Many young adults may be in the early stages of cardiovascular-kidney-metabolic syndrome.
- Engage in heart-healthy habits to slow the disease process or prevent it altogether.
In 2023, the American Heart Association updated its risk factors for heart disease, adding chronic kidney disease (CKD) to the list. This was in addition to the other risk factors, which included high blood pressure, high LDL (“bad”) cholesterol, diabetes, using tobacco, having obesity or overweight, a lack of physical activity, eating an unbalanced diet and drinking too much alcohol.
As a result of adding CKD as a risk factor, the AHA also developed a new construct to encompass the updated factors—cardiovascular-kidney-metabolic (CKM) syndrome—describing the interconnected relationship among obesity, diabetes, chronic kidney disease and cardiovascular disease.
Researchers developed equations that help estimate individuals’ 10- and 30-year risk of heart disease, based on the risk factors mentioned, plus other factors, including age, sex, personal medical history and family medical history. But these equations were developed for adults aged 30 to 79 years old. So researchers from several prominent universities teamed up to estimate heart disease risk in young adults in their 20s. What they found was surprising. Let’s break it down.
How Was This Study Conducted?
The name of this study was the Future of Families—Cardiovascular Health Among Young Adults (FF-CHAYA). It included almost 1,300 participants with diverse ethnicities and an average age of 23; about 54% were women. Using the AHA’s framework for CKM stages, participants were scored from 0 to 4, with 0 being no CKM and 4 being the most advanced stage (none of the participants received a 4 as those with clinical cardiovascular disease were excluded from analysis).
Cardiovascular health was measured using the AHA’s Life’s Essential 8 framework, which scores participants in four areas of health behaviors—diet, physical activity, tobacco use and sleep—and four health markers—weight, cholesterol, blood sugar and blood pressure.
Participants also received an ultrasound of their carotid arteries—the large blood vessels on the sides of the neck that carry blood to the brain. The ultrasound allowed researchers to take a peek into the arteries to check for signs of damage that may indicate the beginning of cardiovascular disease.
What Did This Study Find?
Researchers compared all the scores and stages to see if there were any correlations among the three measures. Overall, about 21% of participants were classified as stage 0 CKM, meaning they had no risk factors. But 40% ranked as stage 1 (due to excess adiposity, or body fat), 36% at stage 2 (due to having metabolic risk factors) and 3% at stage 3 (which means they either had advanced kidney disease or the beginnings of cardiovascular disease.
Here’s what else they observed:
- Compared to stage 0 CKM, participants in stages 1 to 3 had significantly lower Life’s Essential 8 scores.
- Those in stages 1 to 3 also had more changes in their carotid arteries.
- Eight out of 10 participants had some level of CKM, placing them at higher risk of cardiovascular disease.
- As CKM stages advanced, there was a greater association with worsening cardiovascular health, as evidenced by more thickening in the carotid arteries, an early sign of atherosclerosis.
Some notable limitations of this study include self-reporting of health behaviors, which leaves room for bias. Because of the study’s design, causality cannot be established, only that there is a connection between these factors. Lastly, the participants in this study came from disadvantaged backgrounds, so it is unknown whether these results would extend to other socioeconomic demographics.
How Does This Apply to Real Life?
We know that most chronic diseases begin to develop years before a diagnosis. This study suggests that this is true for cardiovascular disease, with signs of it showing up in people in their 20s. The good news is that cardiovascular disease is preventable, so there is a lot you can do starting today for your heart health.
Diet is, perhaps, the most confusing factor when it comes to heart health, as we’re always learning more about the science of eating well. Here are a few things we do recommend:
- Load up on fruits, vegetables and whole grains: The fiber and antioxidants in these foods can help support a healthy heart, even helping with your cholesterol and blood pressure levels.
- Go for lean proteins, including plant protein: From legumes to chicken, mix your proteins up. While many plant proteins are not complete proteins, some are, including soy, quinoa and amaranth. And yes, it’s okay to eat eggs in moderation (and even have some cheese).
- Use unsaturated fats most of the time: This includes olive oil and avocado oil, both of which have been linked to a healthier heart.
- Limit ultra-processed foods: This includes processed red meat and foods high in saturated fats, sodium and added sugars.
In addition to what you eat, other health habits contribute to heart health, too. This includes engaging in regular physical activity, getting plenty of healthy sleep and managing your stress. And be sure to socialize and spend time with loved ones, as depression and loneliness can negatively impact your health, as can using tobacco and consuming alcohol.
Our Expert Take
This study suggests that cardiovascular disease can begin to develop in young adulthood. Because heart disease is largely preventable, it’s important to start taking action now to manage weight, blood pressure, blood sugar and cholesterol levels. If you don’t know your numbers, meet with a healthcare provider to get the appropriate tests, so you have a baseline to work from. Then choose one or two health habits to start working on, adding more over time. The good news is that the same habits that support heart health also support overall health—from the brain to the gut—so your health will benefit on many levels.