Healthy lifestyle change and subclinical atherosclerosis in young adults: Coronary Artery Risk Development in Young Adults (CARDIA) study

Circulation. 2014 Jul 1;130(1):10-7. doi: 10.1161/CIRCULATIONAHA.113.005445. Epub 2014 Apr 28.


Background: The benefits of healthy habits are well established, but it is unclear whether making health behavior changes as an adult can still alter coronary artery disease risk.

Methods and results: The Coronary Artery Risk Development in Young Adults (CARDIA) prospective cohort study (n=3538) assessed 5 healthy lifestyle factors (HLFs) among young adults aged 18 to 30 years (year 0 baseline) and 20 years later (year 20): not overweight/obese, low alcohol intake, healthy diet, physically active, nonsmoker. We tested whether change from year 0 to 20 in a continuous composite HLF score (HLF change; range, -5 to +5) is associated with subclinical atherosclerosis (coronary artery calcification and carotid intima-media thickness) at year 20, after adjustment for demographics, medications, and baseline HLFs. By year 20, 25.3% of the sample improved (HLF change ≥+1); 40.4% deteriorated (had fewer HLFs); 34.4% stayed the same; and 19.2% had coronary artery calcification (>0). Each increase in HLFs was associated with reduced odds of detectable coronary artery calcification (odds ratio=0.85; 95% confidence interval, 0.74-0.98) and lower intima-media thickness (carotid bulb β=-0.024, P=0.001), and each decrease in HLFs was predictive to a similar degree of greater odds of coronary artery calcification (odds ratio=1.17; 95% confidence interval, 1.02-1.33) and greater intima-media thickness (β=+0.020, P<0.01).

Conclusions: Healthy lifestyle changes during young adulthood are associated with decreased risk and unhealthy lifestyle changes are associated with increased risk for subclinical atherosclerosis in middle age.

Keywords: behavior modification; behavioral medicine; cardiovascular diseases; epidemiology; follow-up study; prevention; risk factors.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Alcohol Drinking / epidemiology
  • Body Mass Index
  • Calcinosis / diagnosis
  • Calcinosis / epidemiology
  • Calcinosis / pathology
  • Calcinosis / prevention & control*
  • Carotid Intima-Media Thickness
  • Coronary Artery Disease / diagnosis
  • Coronary Artery Disease / epidemiology
  • Coronary Artery Disease / pathology
  • Coronary Artery Disease / prevention & control*
  • Diet
  • Female
  • Follow-Up Studies
  • Health Behavior*
  • Health Promotion* / organization & administration
  • Humans
  • Life Style*
  • Male
  • Motor Activity
  • Prospective Studies
  • Risk
  • Smoking / epidemiology
  • Surveys and Questionnaires
  • Young Adult