A long-term study found that young adults with strong cardiovascular health profiles tend to keep those advantages and face a much lower risk of heart disease later in life.
Researchers followed 4,241 people who were 18 to 30 years old at the start for nearly 40 years to map lifelong cardiovascular health patterns. Using the American Heart Association’s Life’s Essential 8 (LE8) — a combined score of smoking status, physical activity, diet, sleep, body mass index, blood pressure, cholesterol, and blood glucose — the team identified stable health trajectories that emerged by about age 25 and persisted across adulthood.
Participants fell into four distinct LE8 trajectory groups:
– Persistent high: high LE8 scores at baseline that remained high
– Persistent moderate: mid-level scores that stayed steady
– Moderate declining: mid-level scores that worsened over time
– Moderate/low declining: moderate to low scores that declined further
These groups stayed largely separated as people aged, indicating that behaviors and clinical risk profiles established in young adulthood were durable. Compared with the persistent high group, each lower trajectory carried progressively higher rates of cardiovascular events. People in the least favorable (moderate/low declining) group had roughly a tenfold greater risk of developing cardiovascular disease later in life.
Lead author Donald M. Lloyd-Jones, MD, commented that those with favorable LE8 scores generally maintained them, while many who started with poorer scores experienced further decline. Eiman Jahangir, MD, MPH, noted that cardiovascular health by about age 25 becomes difficult to shift later, highlighting the value of early education and prevention.
The study also showed that participants who improved or worsened over time did not differ substantially from the middle-scoring group, suggesting that early-life cardiovascular status leaves a lasting imprint and that later improvements may not fully erase earlier elevated risk.
Implications and practical steps
The findings underscore the importance of establishing heart-healthy habits in young adulthood or earlier. Adopting and maintaining the Life’s Essential 8 behaviors — stay active, follow a healthy diet, avoid tobacco, get sufficient sleep, and manage weight, blood pressure, cholesterol, and blood glucose — increases the chance of remaining in the healthiest group and lowers long-term disease burden. Regular checkups for blood pressure and cholesterol, guidance on diet and exercise, and tobacco cessation programs are central to prevention.
While early prevention offers the largest payoff, researchers emphasize it’s never too late: making lifestyle and medical improvements at any age can still reduce cardiovascular risk. Consult your healthcare provider to design a plan tailored to your needs.
