Being young does not necessarily mean the heart and blood vessels are free of health risks.
New research involving adults with an average age of just 23 found that most participants had at least one sign of cardiovascular, kidney or metabolic risk. Those with more advanced problems were also more likely to show early injury in their arteries.
The findings offer a different way to think about heart disease. A heart attack may happen suddenly, but the damage that makes it possible can build quietly for decades. Researchers increasingly believe that protecting cardiovascular health should begin long before people reach middle age.
The study focused on cardiovascular-kidney-metabolic health, known as CKM health. The idea recognizes that the heart, kidneys and metabolism are deeply connected. Conditions such as obesity, diabetes, high blood pressure and kidney disease can feed into one another and eventually raise cardiovascular risk.
Blood vessels connect all these systems. High blood sugar can injure vessel walls, while high blood pressure places them under constant strain. Kidney damage can make it harder for the body to control blood pressure and fluid levels, adding further stress to the heart.
To describe how far these problems have progressed, CKM syndrome can be divided into stages from 0 to 4. Stage 0 represents people without identified CKM risk factors. The middle stages include increasing levels of excess body fat, metabolic problems and early disease.
Stage 4 represents established cardiovascular disease, such as heart failure, coronary heart disease or stroke. Moving through the stages is not necessarily inevitable. The goal of prevention is to identify risks early enough to stop or slow progression.
The researchers analyzed health information from 1,283 young adults taking part in the Future of Families–Cardiovascular Health Among Young Adults study. The participants were about 23 years old on average. The researchers determined each person’s CKM stage and separately assessed overall cardiovascular health.
For the second assessment, they used Life’s Essential 8, a framework developed by the American Heart Association. It examines several everyday behaviors and medical measurements that contribute to heart health. The idea is to provide a picture of health that people can understand and potentially improve.
The eight areas include healthy eating, regular physical activity, avoiding tobacco and getting healthy sleep. They also include maintaining a healthy weight and healthy levels of cholesterol, blood sugar and blood pressure. Together, these factors reflect both lifestyle and what is happening inside the body.
The results were striking. Only about 21% of participants had no identifiable CKM risk factors and were classified as stage 0. Nearly four out of five were in stages 1, 2 or 3.
That does not mean nearly 80% of these young adults had advanced disease. Early CKM stages can reflect risk factors such as excess body fat rather than diagnosed heart or kidney disease. Still, the high proportion suggests that potentially important health changes can already be present in early adulthood.
The researchers found another pattern when they compared CKM stages with Life’s Essential 8. People in more advanced CKM stages generally had poorer cardiovascular health scores. This suggests the two approaches capture related but useful information about a person’s health.
The team then looked directly at the participants’ arteries. They used ultrasound to examine the carotid arteries, which are major blood vessels on either side of the neck that carry blood toward the brain. The test can detect subtle changes in artery walls before a person develops symptoms.
More advanced CKM stages were associated with thicker carotid artery walls and other signs of early arterial injury. Thickening can be part of the early development of atherosclerosis. This is the disease process behind many heart attacks and strokes.
Atherosclerosis begins when artery walls become damaged and start accumulating cholesterol, inflammatory cells and other material. Over time, these deposits can form plaques. A plaque can eventually restrict blood flow or rupture and cause a dangerous clot.
Finding early artery changes in people in their 20s is important because it shows how long this process may develop before a cardiovascular emergency occurs. A person may feel completely healthy while risk factors are already affecting the blood vessels. This creates an opportunity for prevention rather than a reason for panic.
Traditional cardiovascular risk calculators are not always helpful at such young ages. The PREVENT equations recommended in current American guidelines estimate 10- and 30-year cardiovascular risk, but they were developed for people aged 30 to 79. They cannot simply be applied to a 23-year-old.
Age also strongly influences short-term risk estimates. Even a young adult with several unhealthy measurements may appear to have low near-term risk because heart attacks and strokes are uncommon in the 20s. That does not mean those risk factors are harmless over a lifetime.
Dr. Donald Lloyd-Jones, an American Heart Association volunteer and cardiovascular prevention expert, said he would focus conversations with people in their 20s on Life’s Essential 8. Improving these measures can support health now while potentially lowering future risk. The framework is designed to be useful across the lifespan.
The study was published in Circulation: Population Health and Outcomes. The researchers concluded that prevention efforts may need to begin earlier than many people assume. Waiting until cardiovascular disease becomes obvious can mean losing years in which risk factors could have been improved.
There are several reasons to be cautious about the findings. The study looked at participants at one point in time, so it cannot establish cause and effect. Researchers cannot yet say that being in a particular CKM stage at 23 will directly lead to a heart attack decades later.
The participants were also not designed to represent every young adult in the population.
The study intentionally included many people from disadvantaged backgrounds, who may experience greater barriers to healthy food, medical care, safe exercise spaces or other resources. The nearly 80% figure therefore should not be assumed to apply to all people in their 20s.
Some behavioral information came from participants themselves rather than objective measurements. Self-reported diet, activity and other habits can be imperfect. The study also examined several health outcomes, meaning future research will be important for confirming the patterns.
The strongest part of the study is that researchers did more than count common risk factors. They also used ultrasound to look for physical changes in arteries. The connection between more advanced CKM stages and early arterial injury gives the findings greater biological importance.
Long-term follow-up is now needed. Researchers need to learn whether young adults with higher CKM stages continue to develop artery damage and whether they eventually experience more heart disease, stroke or kidney problems. Such evidence could help doctors decide how aggressively to address early risks.
For young adults, the practical lesson is simple: heart health is relevant even when heart disease feels decades away.
Knowing blood pressure, avoiding tobacco, staying active, sleeping well and keeping blood sugar and cholesterol in healthy ranges can help build a stronger foundation. Small improvements made in the 20s have the advantage of potentially working for the body for many years.
Source: American Heart Association.
