Association Between the Ideal Cardiovascular Health Score and Cardiovascular-Kidney Outcomes in Young Adults

Abstract

Rationale & objective: The linkage between cardiovascular disease (CVD) and kidney disease and the importance of promoting cardiovascular health (CVH) to prevent them are increasingly recognized. This study investigated the associations of ideal CVH and its longitudinal change with cardiovascular-kidney outcomes in young adults.

Study design: Retrospective cohort study.

Setting & participants: From nationwide health screening data, we identified adults aged 20-39 years without prior CVD or kidney disease who underwent baseline health examinations in 2009-2010 (N = 3,836,626).

Exposure: Using a modified American Heart Association Life's Simple 7 construct excluding dietary data, the participants were categorized according to the number of ideal CVH components they met. Participants who underwent follow-up health examinations between 2011 and 2014 (N=2,728,675) were additionally categorized by the combination of baseline and follow-up CVH scores.

Outcome: A composite of cardiovascular or kidney event. Cardiovascular events included myocardial infarction, ischemic stroke, heart failure, and death from CVD. Kidney events included incident chronic kidney disease, kidney replacement therapy, and death from kidney disease.

Analytical approach: Cause-specific proportional hazards model.

Results: During a median follow-up of 12.1 years, 134,317 composite cardiovascular or kidney events occurred. Multivariable-adjusted risk of the event decreased stepwise with higher CVH scores (for a CVH score of 6 vs 0: HR, 0.32 [95% CI, 0.30-0.34]). An increase in CVH score from baseline (2009-2010) to follow-up (2011-2014) examination was associated with lower risk of the event (HR, 0.86 [95% CI, 0.86-0.87] per+1 CVH score change). Moreover, the risk was lower in participants who maintained high CVH scores at both baseline and follow-up examinations than in those who newly achieved a high CVH score at follow-up examination (HR, 0.87 [95% CI, 0.86-0.87] per+1 baseline CVH score).

Limitations: Diet data were not included in CVH score.

Conclusions: In young adults, achieving and maintaining high CVH was associated with reduced risk of cardiovascular-kidney outcomes.

Plain-language summary: Cardiovascular disease (CVD) and kidney disease are closely connected, influencing each other from an early age. We explored whether achieving and maintaining good cardiovascular health (CVH) in young adulthood was associated with the prevention of future CVD and kidney disease. Our findings showed that young adults with better CVH had a lower risk of developing these conditions later in life. Improving CVH over time led to reduced risk, and maintaining good CVH from the start was even more beneficial. These results highlight the importance of achieving and sustaining good CVH early in life to help prevent CVD and kidney disease over time.