Background: The prevalence of Ideal Cardiovascular Health (CVH) decreases with age, beginning in childhood. However, more precise estimates of trajectories of CVH across the lifespan are needed to guide intervention. The aims of this analysis are to describe trajectories in CVH from childhood through middle age and examine whether there are critical inflection points in the decline in CVH.
Methods: We pooled data from five prospective childhood/early adulthood cohorts including Bogalusa, Young Finns, HB!, CARDIA, and STRIP. Clinical CVH factors—blood pressure, BMI, cholesterol, glucose—were categorized as poor, intermediate and ideal then summed to create a clinical CVH score, ranging from 0 to 8 (higher score= more ideal CVH). The association between clinical CVH score and age in years was modeled using a segmented linear mixed model, with a random participant intercept, fixed slopes, and fixed change points. Change points were estimated using an extension of the R package ‘segmented’ which utilizes a likelihood based approach to iteratively determine one or more change points. All models were adjusted for race, gender and cohort.
Results: This study included 18,290 participants (51% female, 67% White, 46% between the ages of 8-11 at baseline). CVH scores decline with age from 8 through 55 years. We found two ages at which the slope of the CVH trajectories change significantly. CVH scores are generally stable from age 8 until the first change point at age 17 (95% CI 16.3-17.4), when they begin to decline more rapidly with a 0.08 CVH unit loss per year from age 17 to 30. The second change point occurs at age 30 (26.7-33.6) when the rate of decline increases by an additional 0.01 units per year.
Conclusion: The clinical CVH score declines from favorable levels from childhood through adulthood, with a rapid decline starting at age 17 that becomes slightly steeper from age 30 to 55 years. These inflection points signal that there are critical periods in an individual’s clinical CVH trajectory during which prevention efforts may be targeted.