Influential Periods in Longitudinal Clinical Cardiovascular Health Scores

Amy E. Krefman, Darwin Labarthe, Philip Greenland, Lindsay Pool, Liliana Aguayo, Markus Juonala, Mika Kähönen, Terho Lehtimäki, R. Sue Day, Lydia Bazzano, Vito M.R. Muggeo, Linda Van Horn, Lei Liu, Larry S. Webber, Katja Pahkala, Tomi T. Laitinen, Olli Raitakari, Donald M. Lloyd-Jones, Norrina B. Allen

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


The prevalence of ideal cardiovascular health (CVH) among adults in the United States is low and decreases with age. Our objective was to identify specific age windows when the loss of CVH accelerates, to ascertain preventive opportunities for intervention. Data were pooled from 5 longitudinal cohorts (Project Heartbeat!, Cardiovascular Risk in Young Finns Study, The Bogalusa Heart Study, Coronary Artery Risk Development in Young Adults, Special Turku Coronary Risk Factor Intervention Project) from the United States and Finland from 1973 to 2012. Individuals with clinical CVH factors (i.e., body mass index, blood pressure, cholesterol, blood glucose) measured from ages 8 to 55 years were included. These factors were categorized and summed into a clinical CVH score ranging from 0 (worst) to 8 (best). Adjusted, segmented, linear mixed models were used to estimate the change in CVH over time. Among the 18,343 participants, 9,461 (52%) were female and 12,346 (67%) were White. The baseline mean (standard deviation) clinical CVH score was 6.9 (1.2) at an average age of 17.6 (8.1) years. Two inflection points were estimated: At 16.9 years (95% confidence interval: 16.4, 17.4) and at 37.2 years (95% confidence interval: 32.4, 41.9). Late adolescence and early middle age appear to be influential periods during which the loss of CVH accelerates.

Original languageEnglish
Pages (from-to)2384-2394
Number of pages11
JournalAmerican journal of epidemiology
Issue number11
StatePublished - Nov 1 2021


  • adolescence
  • cardiovascular epidemiology
  • cardiovascular health
  • cohort studies
  • longitudinal studies
  • prevention
  • risk factors


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