By Nicholas Fox, Nolan Fox, Dorothy M. Davis, Roger S. Blumenthal, Miguel Cainzos-Achirica
Atherosclerosis—hardening of the arteries with fat and cholesterol—is the main cause of cardiovascular disease. It can lead to heart attacks, strokes, heart failure, the need for arterial bypass or stenting procedures, and abnormal heart rhythms.
Teens and young adults (those 13–35 years old) can do a lot today that would keep their hearts healthier later in life. It’s important for younger individuals to learn what increases their chance of developing heart disease and how to monitor those risk factors. By doing so, they may be able to make lasting improvements in their lifestyle habits.
However, there are challenges. Younger individuals are less likely to follow a healthy diet than older individuals, and average body mass indices (BMI) and blood pressure levels have slowly but steadily risen in recent decades. As a result, more people are at higher risk of obesity, diabetes, and heart disease. Additionally, young adulthood is a transition period during which many are switching between pediatric- and adult-centered care. They may delay or forgo health checkups due to time or financial constraints. This could allow heart risk factors (such as high blood pressure, elevated cholesterol, and/or blood sugar) to develop and progress without detection.
Many young individuals—as well as adults—don’t know how to improve their cardiovascular health or follow a heart-healthy lifestyle. That is why the American College of Cardiology (ACC) and the American Heart Association (AHA) recently released a comprehensive set of recommendations to help prevent cardiovascular disease among healthy individuals.
Below you will find six takeaways from the 2019 Guideline on the Primary Prevention of Cardiovascular Disease to help young adults improve their heart health.
Assess Heart Risk. Traditionally, only 40- to 75-year-old individuals were advised to regularly meet with a physician to assess their risk for atherosclerotic cardiovascular disease (ASCVD, or disease due to hardened arteries). The 2019 Primary Prevention Guideline recommends, however, that everyone by age 20 talk to their health care professional about their long-term chance of developing heart disease and how to assess it. Using the ACC/AHA long-term (30-year) risk estimator for heart attack or stroke can increase motivation to make timely lifestyle changes and to stick to them.
Control Blood Pressure. With the increasing prevalence of high blood pressure in younger individuals in the U.S., young adults should check their blood pressure periodically. According to the guideline, individuals with a blood pressure consistently greater than 130/80 have an increased risk of developing heart disease. It is important to focus on dietary improvements, sodium (salt) reduction, stress reduction, and increased aerobic activity because sustained healthy habits are key to controlling blood pressure. However, if your blood pressure is consistently greater than 140/90 after a period of sustained lifestyle improvements, talk to your health care professional. You may need medication to lower it in addition to healthy habits.
Manage Cholesterol. Elevated cholesterol levels are one of the main causes of heart disease. Specifically, low-density lipoprotein cholesterol (LDL or “bad” cholesterol) is a primary factor for the hardening of the arteries. Of note, early signs of disease were already present in the majority of younger individuals with cardiovascular disease by the age of 15, according to the Pathobiological Determinants of Atherosclerosis in Youth study. The study also found that the prevalence and extent of atherosclerosis increased steadily from age 15 onward. These findings stress the importance of young adults assessing their LDL levels to better understand their heart disease and stroke risk. Better dietary and exercise habits are always the first step in managing high cholesterol, and they continue to be important even if a cholesterol-lowering medication (usually a statin) is prescribed.
Eat Better. It is estimated that fewer than 10% of young adults and adolescents in the U.S. have ideal dietary habits. The guideline emphasizes a healthy diet rich in vegetables, fruits, legumes (for example beans), nuts, whole grains and fish. Also, it recommends you minimize the intake of saturated fats, processed meats such as sausage, bacon, hot dogs, as well as refined carbohydrates and sweetened beverages. Try to avoid trans fats altogether.
Move More. The lack of regular, brisk physical activity is a major preventable heart risk factor for young adults. On average, just one-third of younger individuals have ideal physical activity patterns, and many are sedentary. Many experts use the phrase “sitting is the new smoking” to emphasize how spending long periods of time without moving has been linked to increases in heart risk factors. By engaging in at least 150 minutes of moderate intensity exercise or 75 minutes of vigorous intensity exercise each week, younger individuals can improve their heart health substantially.
Quit Smoking. With the emergence and popularity of e-cigarette and nicotine vaporizing devices among young adults, concern for health risks in this age group are increasing. Cigarette smoking has devastating effects on cardiovascular health and increases the risk of several major types of cancer. Any level or form of tobacco use increases risk for heart disease.
While the modern tobacco-less vaping devices (for example Juul, vape pens) have been considered to have less harmful effects than traditional cigarettes, long-term nicotine use is still linked to decreased heart health. “Juuling” and vaping likely damage blood vessels and increase the risk of heart disease. Cessation of cigarette smoking and any vaping method can greatly improve your heart health. If you are struggling to quit, ask for help from a health care professional. Call the toll-free line 1-800-QUIT-NOW to get started.
Reducing risk of developing life-threatening heart disease begins with basic lifestyle changes, and access to accurate information is key. Younger individuals have the chance to influence friends, family members and peers in a unique way through social networks. By becoming informed and disseminating tips based on recommendations like those listed here, they have the potential to improve lives and shape a healthier generation.
Nicholas Fox and Nolan Fox are premedical students at Drexel University. Dorothy M. Davis, MSN RN is a cardiovascular nurse health educator at the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease. Roger S. Blumenthal, MD, FACC, co-chair of the 2019 Primary Prevention Guideline writing committee, and Miguel Cainzos Achirica, MD, MPH, also work at the Johns Hopkins Ciccarone Center.