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Healthy Lifestyle Through Young Adulthood and the Presence of Low Cardiovascular Disease Risk Profile in Middle Age: The Coronary Artery Risk Development in (Young) Adults (CARDIA) Study
Open accessAbstract
Background—: A low cardiovascular disease risk profile (untreated cholesterol <200 mg/dL, untreated blood pressure <120/<80 mm Hg, never smoking, and no history of diabetes mellitus or myocardial infarction) in middle age is associated with markedly better health outcomes in older age, but few middle-aged adults have this low risk profile. We examined whether adopting a healthy lifestyle throughout young adulthood is associated with the presence of the low cardiovascular disease risk profile in middle age. Methods and Results—: The Coronary Artery Risk Development in (Young) Adults (CARDIA) study sample consisted of 3154 black and white participants 18 to 30 years of age at year 0 (1985–1986) who attended the year 0, 7, and 20 examinations. Healthy lifestyle factors defined at years 0, 7, and 20 included average body mass index <25 kg/m 2 , no or moderate alcohol intake, higher healthy diet score, higher physical activity score, and never smoking. Mean age (25 years) and percentage of women (56%) were comparable across groups defined by number of healthy lifestyle factors. The age-, sex-, and race-adjusted prevalences of low cardiovascular disease risk profile at year 20 were 3.0%, 14.6%, 29.5%, 39.2%, and 60.7% for people with 0 or 1, 2, 3, 4, and 5 healthy lifestyle factors, respectively ( P for trend <0.0001). Similar graded relationships were observed for each sex-race group (all P for trend <0.0001). Conclusions—: Maintaining a healthy lifestyle throughout young adulthood is strongly associated with a low cardiovascular disease risk profile in middle age. Public health and individual efforts are needed to improve the adoption and maintenance of healthy lifestyles in young adults.
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In the citing paper
“Prevention is effective in reducing the impact of CVD”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [3]
In the citing paper
“the elimination of health risk behaviours would make it possible to prevent at least 80% of CVD and even 40% of cancers”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [3]
In the citing paper
“the elimination of health risk behaviours would make it possible to prevent at least 80% of CVD and even 40% of cancers, thus providing added value for other chronic diseases.3,4”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [3]
In the citing paper
“Findings from the Coronary Artery Risk Development in Young Adults (CARDIA) study demonstrate that young adults aged 18 to 30 years with healthy behaviors grow up to become older adults with lower biological risk.12”
From Better Population Health Through Behavior Change in Adults: A Call to Action (2013) · cites this paper as [12]
In the citing paper
“Moreover, highlighting the promise of behavior change, those who did not have a healthy lifestyle at baseline but began to practice healthy behaviors later still had higher rates of ideal cardiovascular biomarkers than those who never adopted healthy behaviors.”
From Better Population Health Through Behavior Change in Adults: A Call to Action (2013) · cites this paper as [12]
In the citing paper
“These results indicate that regardless of timing, the adoption of a healthy lifestyle has value for cardiovascular health.12”
From Better Population Health Through Behavior Change in Adults: A Call to Action (2013) · cites this paper as [12]
In the citing paper
“Among those who practiced all of 5 healthy lifestyle behaviors in young adulthood (nonsmoking, low or no alcohol use, healthy diet, physically active, maintenance of normal weight), 60% had all ideal cardiovascular biomarkers in middle age.”
From Better Population Health Through Behavior Change in Adults: A Call to Action (2013) · cites this paper as [12]
In the citing paper
“In contrast, of those who practiced none of these healthy behaviors in young adulthood, fewer than 5% reached middle age with all cardiovascular biomarkers at ideal levels.12”
From Better Population Health Through Behavior Change in Adults: A Call to Action (2013) · cites this paper as [12]
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Better together: The impact of exercising with a romantic partner
Sackett-Fox, K., Gere, J., & Updegraff, J. A. (2021) · Journal of Social and Personal Relationships · doi:10.1177/02654075211012086 · Cited by 14
“We focused on a sample of young adults, as this time period is particularly important for promoting and establishing active lifestyles (Liu et al., 2012), and exercise routines established during this time period are often sustained throughout the lifespan (Nelson et al.”
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“…Was the follow up time reported and sufficient to be long enough for outcomes to occur?, 9) Was follow up complete, and if not, were reasons to loss to follow up described and explored?, 10) Were strategies to address incomplete follow up utilized?, 11) Was appropriate statistical analysis used?.”
MethodMartino, F., Bassareo, P. P., Martino, E., Romeo, F., Calcaterra, G., Filardi, P. P., Indolfi, C., Nodari, S., Montemurro, V., Guccione, P., et al. (2023) · Journal of Cardiovascular Medicine · doi:10.2459/jcm.0000000000001488 · Cited by 15
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“The 4 scores were summed and the higher 40 percentile considered a healthier diet (Daviglus et al. 2012; Liu et al. 2012).”
BackgroundThe Impact of Preeclampsia on Women’s Health: Cardiovascular Long-term Implications
Orabona, R., Sciatti, E., Sartori, E., Vizzardi, E., & Prefumo, F. (2020) · Obstetrical & Gynecological Survey · doi:10.1097/ogx.0000000000000846 · Cited by 14
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Reducing Stroke in Women with Risk Factor Management: Blood Pressure and Cholesterol
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To your health!: Re-examining the health benefits of moderate alcohol use
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“Regular physical activity during young adulthood reduces risk for cardiovascular events in midlife (Liu et al., 2012).”
The metabolic syndrome and associated lifestyle factors among the Iranian population
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“Adopting healthy lifestyle behaviors in middle age can result in lower cardiovascular disease (CVD) and mortality.[17] However, the modern lifestyle modification therapy combines specific recommendations on diet and exercise with behavioral and cognitive strategies.”
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“ASCVD can be prevented to a great extent by a healthy lifestyle [3].”
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“Introduction The significance of the modifiable risk factors in development of cardiovascular disease (CVD) is well documented [1, 2].”
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“Our data indicate the importance of LR profile and healthy lifestyles favorably influencing RFs in early adulthood (Liu et al., 2012), as they are associated with lower risk of systemic inflammation, which may play a role in the pathogenesis of coronary atherosclerosis (Libby et al., 2002; Ross,…”
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Stroke Counseling Intervention for Young Adult African Americans
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“Participants’ LS7 scores ranged from 4.3 to 8.6, with anaverageof 7.2 (SD=1.2)out of 10, considered less than ideal.”
BackgroundMethodInfluential
Metadata
- Authors
- Liu, K., Daviglus, M. L., Loria, C. M., Colangelo, L. A., Spring, B., Moller, A. C., & Lloyd-Jones, D. M.
- Affiliations
- Northwestern University (US)
- From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L., M.L.D., L.A.C., B.S., A.C.M., D.M.L.-J.), and National Heart, Lung, and Blood Institute, National Institute of Health, Bethesda, MD (C.M.L.).
- ORCID
- Venue
- Circulation
- Published
- 2012-02-28
- Volume
- 125
- Issue
- 8
- Pages
- 996-1004
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC3353808
- OpenAlex
- W2114377026
- Cited by
- 371
- References
- 46
- Citations by year
- 2026: 18 · 2025: 18 · 2024: 24 · 2023: 30 · 2022: 28 · 2021: 46 · 2020: 28 · 2019: 23 · 2018: 30 · 2017: 22 · 2016: 26 · 2015: 22 · 2014: 18 · 2013: 23 · 2012: 14
- FWCI
- 15.85
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (n01hc95095-66-0-1, n01hc48047-55-0-1, n01hc48049-61-0-1)
- National Heart, Lung, and Blood Institute (N01 HC 95095, N01-HC-048049, N01 HC095095, N01 HC048047, N01-HC-480-47)
- National Center for Research Resources (UL1RR025741)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health and Lifestyle Studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- healthy lifestyle, early adulthood, middle age (human life stage), body mass index, alcohol consumption, healthy eating, physical activity, never smoking, untreated hypertension, CARDIA study, sex differences, racial differences
- MeSH terms
- Adult, Age Factors, Cardiovascular Diseases, Coronary Artery Disease, Female, Humans, Life Style, Longitudinal Studies, Male, Middle Aged, Risk Factors, Cohort Studies, Young Adult
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