title: Optimal Lifestyle Components in Young Adulthood Are Associated With Maintaining the Ideal Cardiovascular Health Profile Into Middle Age.
abstract: BACKGROUND
  Middle-aged adults with ideal blood pressure, cholesterol, and glucose levels exhibit substantially lower cardiovascular mortality than those with unfavorable levels. Four healthy lifestyle components-optimal body weight, diet, physical activity, and not smoking-are recommended for cardiovascular health (CVH). This study quantified associations between combinations of healthy lifestyle components measured in young adulthood and loss of the ideal CVH profile into middle age.
  
  
  RESULTS
  Analyses included 2164 young adults in the Coronary Artery Risk Development in Young Adults study with the ideal CVH profile (defined as untreated blood pressure <120/80 mm Hg, total cholesterol <200 mg/dL, fasting blood glucose <100 mg/dL, and absence of cardiovascular disease) at baseline. Cox proportional hazards regression models estimated hazard ratios for loss of the ideal CVH profile over 25 years according to 4 individual and 16 combinations of optimal healthy lifestyle components measured in young adulthood: body mass index, physical activity, nonsmoking status, and diet quality. Models were adjusted for age, sex, race, education, study center, and baseline blood pressure, cholesterol, and glucose. Eighty percent (n=1737) of participants lost the ideal CVH profile by middle age; loss was greatest for young adults with no optimal healthy lifestyle components at baseline. Relative to young adults with no optimal healthy lifestyle components, those with all 4 were less likely to lose the ideal CVH profile (hazard ratio 0.59, 95% CI 0.44-0.80). Combinations that included optimal body mass index and nonsmoking status were each associated with lower risk.
  
  
  CONCLUSIONS
  Optimal body mass index and not smoking in young adulthood were protective against loss of the ideal CVH profile through middle age. Importance of diet and physical activity may be included through their effects on healthy weight.
authors.affiliation: Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA (H.C.G.).
authors.forename: Holly C
authors.initials: HC
authors.lastname: Gooding
authors.affiliation: Gillings School of Global Health, University of North Carolina Chapel Hill, Chapel Hill, NC (C.M.S.).
authors.forename: Christina M
authors.initials: CM
authors.lastname: Shay
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (H.N., N.B.A., D.M.L.J.).
authors.forename: Hongyan
authors.initials: H
authors.lastname: Ning
authors.affiliation: Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, MA (M.W.G.).
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Gillman
authors.affiliation: Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (S.E.C.).
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Chiuve
authors.affiliation: Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.P.R.).
authors.forename: Jared P
authors.initials: JP
authors.lastname: Reis
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (H.N., N.B.A., D.M.L.J.).
authors.forename: Norrina B
authors.initials: NB
authors.lastname: Allen
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (H.N., N.B.A., D.M.L.J.).
authors.forename: Donald M
authors.initials: DM
authors.lastname: Lloyd-Jones
mesh_terms: D000328:Adult; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D015992:Body Mass Index; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control; D004032:Diet / Q000009:adverse effects; D050171:Dyslipidemias / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control; D015444:Exercise; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D056865:Ideal Body Weight; D053208:Kaplan-Meier Estimate; D008019:Life Style; D016014:Linear Models; D008055:Lipids / Q000097:blood; D008137:Longitudinal Studies; D008875:Middle Aged; D009043:Motor Activity; D009765:Obesity / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D011379:Prognosis; D016016:Proportional Hazards Models; D065840:Protective Factors; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D000074606:Smoking Prevention; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D008055:Lipids
keywords: cardiovascular disease; cardiovascular health; health behaviors; young adults