The Urgent Need to Refocus Cardiovascular Disease Prevention Efforts on Young Adults

Abstract

Life expectancy in the US is now the lowest it has been since 1996, with young-and middle-aged adults seeing the most rapid declines. 1,2 These declines began in 2014 and have accelerated over the past 3 years of the pandemic. While COVID-19 represents a significant proportion, increases in heart disease between 2020 and 2021 explain more than 4% of the most recent shortening in life expectancy. 2 These increases in cardiovascular mortality reflect recent disturbing trends in cardiovascular risk determinants and events in younger adults. 3,4 Although overall cardiovascular disease mortality declined until 2020, hospitalization and death rates flattened or in some cases increased among specific racial and ethnic subgroups of young adults during this time. 3,5,6 In particular, hypertensive heart disease, heart failure, and endocarditis have increased in young adults, particularly among Black individuals, through 2018. 7 Consequently, young adults make up a growing proportion of cardiovascular disease events, with the proportion of premature myocardial infarction among adults younger than 40 years increasing by 2% every year. 8 The increasing event rates observed among younger adults can be attributed to the increasing prevalence and onset of risk factors such as obesity and hypertension at younger ages, which exacerbate cumulative exposure and cardiovascular disease risk over near-and longterm time horizons. 9 In this issue of JAMA, Aggarwal and colleagues 10 used the most recent data from the National Health and Nutrition Examination Surveys (NHANES) to examine trends in diagnosis, treatment, and control of cardiovascular risk factors among young adults (aged 20-44 years) from 2009 through 2020. Their findings clearly demonstrate that the burden of cardiovascular risk factors is unacceptably high and increasing in young adults. The age-adjusted prevalence of obesity, hypertension, and diabetes increased from 33% to 40.9%, from 9% to 11.5%, and from 2% to 4.1%, respectively, from 2009 to 2017-2020. Only the rates of hyperlipidemia decreased between 2009 and 2020, with age-adjusted rates decreasing from 41% to 36%. Despite declines in tobacco prevalence in older adults in the US, smoking prevalence remained constant in young adults during the study period. Importantly, the study demonstrates that despite current efforts, rates of controlled hypertension and diabetes remain low among young adults with these conditions.These most recent findings within NHANES also highlight the growing inequities in cardiovascular health across racial and ethnic subpopulations in the US. Black young adults had twice the prevalence of hypertension as all other racial and

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