Cumulative Cardiovascular Health Score Through Young Adulthood and Cardiovascular and Kidney Outcomes in Midlife

Importance Positive health outcomes of a high cardiovascular health (CVH) score have been demonstrated largely with single CVH assessments in midlife, whereas the association of cumulative CVH during young adulthood with premature cardiovascular disease (CVD) and particularly kidney outcomes remains unclear. Objective To examine the association of cumulative CVH from 30 to 40 years of age with the risk of CVD and kidney events in midlife. Design, Setting, and Participants This population-based cohort study used Korean National Health Insurance health screening and claims data on adults aged 40 years without prior CVD or chronic kidney disease (CKD). Data were analyzed from May 1, 2024, to April 30, 2025. Exposure Ten-year cumulative CVH score, calculated as the area under the CVH score curve from 30 to 40 years of age (range, 0-100 per visit; cumulative range, 0-1000 points × years), based on the American Heart Association’s Life’s Essential 8 construct. Main Outcomes and Measures The primary outcomes were CVD events (myocardial infarction, ischemic stroke, heart failure, or cardiovascular death) and kidney events (incident CKD, kidney replacement therapy, or kidney-related death) after 40 years of age among participants. Results Among 241 924 adults (78.1% male [n = 188 871]; all aged 40 years) with 3 or more examination visits (at 30 and 40 years of age and ≥1 visits in between; median number of visits, 8 [IQR, 6-10]), 2748 CVD events and 2085 kidney events occurred over a median follow-up of 9.2 years (IQR, 8.4-10.1). The highest quintile (quintile 5 [Q5]; ≥735 points × years) of cumulative CVH from 30 to 40 years of age was associated with a very low incidence of CVD (0.05% per year; adjusted hazard ratio [HR], 0.27 [95% CI, 0.22-0.32] vs Q1) and kidney events (0.05% per year; adjusted HR, 0.25 [95% CI, 0.21-0.31] vs Q1) in midlife. Each 100-point × year higher cumulative CVH (eg, 10-point higher CVH score × 10 years) was associated with a 34% lower hazard of CVD events and a 35% lower hazard of kidney events. The associations were similar by sex and for event subtypes and remained significant after adjustment for CVH score at 40 years of age or the slope of CVH change. Conclusions and Relevance These findings suggest that a higher cumulative CVH score from 30 to 40 years of age was associated with markedly lower risks of CVD and kidney events in midlife, highlighting the importance of sustained primordial prevention efforts throughout early life.