Cardiovascular health across the lifespan: developing a novel prediction model

Background and Significance: Cardiovascular disease (CVD) remains the number one cause of death in the United States.1 Recent epidemiologic studies have found that those who reach mid-adulthood without CVD or traditional CVD risk factors experience exceedingly long life-spans in good health with markedly lower risk of developing CVD later in life.2-10 However, very few American adults – under 10% - reach mid-adulthood without developing CVD or any major CVD risk factors.1 Because virtually all children are born without CVD risk factors, key questions are why and how some people are able to maintain cardiovascular (CV) health until middle age and others are not. Despite the importance of these questions for pediatric and public health practice, few studies have addressed factors in youth that lead to CV health in adulthood,11-14 and none have examined childhood and adolescent determinants of CV health. In order to study pediatric factors essential for maintenance of CV health across the life course, we must first identify those factors in early young adulthood most predictive of mid-life CV health (see figure) and the morbidity and mortality benefit this confers. This study will use the Coronary Artery Risk Development in Young Adults (CARDIA) study to determine: Aims and Hypotheses: Aim 1: Physiologic and behavioral factors in early young adulthood that best predict maintenance of physiologic CV health (untreated total cholesterol <200 mg/dL, untreated blood pressure <120/<80 mm Hg, untreated fasting glucose <100 mg/dL and no history of diabetes mellitus or myocardial infarction) from young to mid-adulthood. H1a. Normal body mass index, healthy diet score, and high physical activity levels will be most strongly associated with survival to mid-adulthood with physiologic CV health. H1c. The full cluster of having optimal BMI, physical activity levels, dietary habits and never-smoking status in early young adulthood will have high sensitivity and moderate