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J Am Coll Cardiol. 2019 Jul 23;74(3):330-341. doi: 10.1016/j.jacc.2019.03.529.

Associations of Blood Pressure and Cholesterol Levels During Young Adulthood With Later Cardiovascular Events.

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Division of General Medicine, Columbia University, New York, New York.
Department of Epidemiology and Biostatistics, School of Medicine, University of California-San Francisco, San Francisco, California.
Department of Preventive Medicine, Northwestern University, Chicago, Illinois.
Division of Epidemiology and Population Health Sciences, Department of Public Health Sciences, University of Miami, Miami, Florida.
Departments of Psychiatry, Neurology, and Epidemiology, University of California-San Francisco, San Francisco, California.
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Departments of Epidemiology, Medicine and Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
Divisions of Cardiology and Research, Kaiser Permanente Northern California, Oakland, California.
Department of Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts; The Boston University and the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts.
Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.
Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
Division of General Medicine, Columbia University, New York, New York. Electronic address:



Blood pressure (BP) and cholesterol are major modifiable risk factors for cardiovascular disease (CVD), but effects of exposures during young adulthood on later life CVD risk have not been well quantified.


The authors sought to evaluate the independent associations between young adult exposures to risk factors and later life CVD risk, accounting for later life exposures.


The authors pooled data from 6 U.S. cohorts with observations spanning the life course from young adulthood to later life, and imputed risk factor trajectories for low-density lipoprotein (LDL) and high-density lipoprotein cholesterols, systolic and diastolic BP starting from age 18 years for every participant. Time-weighted average exposures to each risk factor during young (age 18 to 39 years) and later adulthood (age ≥40 years) were calculated and linked to subsequent risks of coronary heart disease (CHD), heart failure (HF), or stroke.


A total of 36,030 participants were included. During a median follow-up of 17 years, there were 4,570 CHD, 5,119 HF, and 2,862 stroke events. When young and later adult risk factors were considered jointly in the model, young adult LDL ≥100 mg/dl (compared with <100 mg/dl) was associated with a 64% increased risk for CHD, independent of later adult exposures. Similarly, young adult SBP ≥130 mm Hg (compared with <120 mm Hg) was associated with a 37% increased risk for HF, and young adult DBP ≥80 mm Hg (compared with <80 mm Hg) was associated with a 21% increased risk.


Cumulative young adult exposures to elevated systolic BP, diastolic BP and LDL were associated with increased CVD risks in later life, independent of later adult exposures.


blood pressure; cholesterol; coronary heart disease; heart failure; stroke; young adulthood

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