A new scientific study published today in Circulation: Population Health and Outcomes, a peer-reviewed journal of the American Heart Association, reveals that nearly 8 out of 10 young adult participants, average age 23, already have cardiovascular-kidney-metabolic (CKM) syndrome. The findings highlight the urgent need for cardiovascular disease prevention efforts to begin earlier in life, as even individuals in their early 20s show signs of arterial injury.
The study assessed 1,283 participants from the Future of Families–Cardiovascular Health Among Young Adults (FF-CHAYA) study, a diverse cohort with an average age of 23. Researchers determined each participant's CKM syndrome stage and their Life's Essential 8 cardiovascular health score, then used ultrasound imaging to check for arterial injury in the carotid arteries. The results showed that nearly 80% of participants met criteria for CKM syndrome stage 1, 2, or 3, meaning they already had excess adiposity, metabolic risk factors, or evidence of subclinical cardiovascular disease. Only about 21% had no identifiable risk factors (Stage 0), and none were in stage 4.
Importantly, the study found that more advanced CKM syndrome stages were associated with poorer Life's Essential 8 scores and early signs of arterial injury, including thicker carotid artery walls, which is an early marker of atherosclerosis. This suggests that the path to cardiovascular disease may begin much earlier than previously thought, emphasizing the need for early intervention.
“The study shows that CKM syndrome staging and Life's Essential 8 are complementary for identifying adults younger than age 30 who may be on the fast track for arterial injury, plaque build-up and, ultimately, at higher risk for future cardiovascular events,” said study author Donald Lloyd-Jones, M.D., M.S., an American Heart Association volunteer, cardiologist at Boston Medical Center, and professor at Boston University's Chobanian & Avedisian School of Medicine. Lloyd-Jones, also principal investigator of the Framingham Heart Study, noted that current risk prediction tools like the PREVENT equations are not applicable to people under 30, so clinicians should focus on optimizing Life's Essential 8 metrics.
The American Heart Association's Life's Essential 8 comprises health behaviors and health factors: healthy eating, physical activity, avoiding tobacco, healthy sleep, healthy weight, healthy cholesterol, healthy blood sugar, and healthy blood pressure. These metrics provide a framework for measuring and improving cardiovascular health at any age.
The implications of this study are significant. With obesity rates climbing to about 40% of adults and 20% of youth in 2023, as noted in the release, the findings underscore the importance of early prevention. The study authors suggest that improving cardiovascular health in young adulthood could prevent disease progression long before clinical cardiovascular disease appears. They call for more research to determine how CKM syndrome stage in young adulthood relates to future cardiovascular risk.
While the study has limitations, including its cross-sectional design and the inclusion of many individuals from disadvantaged backgrounds, the message is clear: cardiovascular risk assessment and lifestyle interventions should start in the 20s, not later. “For people in their 20s, we want to focus on improving cardiovascular health,” Lloyd-Jones said. The study provides a compelling case for integrating Life's Essential 8 into routine care for young adults to halt the progression of arterial damage and reduce the future burden of heart disease, stroke, and kidney disease.
