Heart disease begins long before we start worrying about health

Everyone talks about healthy aging. Few talk about when it really starts. Heart disease does not appear overnight. It builds quietly, year after year, often beginning when life feels too young to worry about health.

A new study from Boston University reminds us that what happens in our twenties may decide how our hearts perform decades later.

Heart disease starts early

Researchers in the Chobanian and Avedisian School of Medicine followed thousands of young adults for more than forty years. The team tracked how heart health changed from age 18 and how those changes influenced disease later in life.

Dr. Donald Lloyd-Jones is a professor of medicine and director of the Framingham Heart Study.

“While research has begun to characterize cardiovascular health in young adults and its long-term association with premature cardiovascular disease, few studies have examined longitudinal patterns of heart health in young adulthood,” noted Dr. Lloyd-Jones.

“Our current observation indicates that change matters; improvements in heart health can decrease future risk, and the earlier it is attained and maintained, the better.”

Early habits shape risk

Each person received a heart health score using the American Heart Association’s Life’s Essential 8 (LE8). It measures eight habits – diet, activity, sleep, body weight, blood pressure, cholesterol, blood sugar, and tobacco use.

Over 20 years, patterns began to appear. Some maintained strong scores. Others slipped little by little. A few started healthy and lost ground fast.

People who kept high scores had the lowest chance of heart attacks and strokes later. Those with moderate scores faced about twice the risk.

The group that started average and dropped over time had ten times the risk. A drop of just ten points in LE8 raised cardiovascular disease risk by more than fifty percent.

What’s driving health declines?

Health declines rarely happen by accident. Many people leave school, take on work stress, sleep less, eat poorly, or skip regular checkups.

The study noted that women usually held better heart health than men. Participants with more education or stable income also stayed healthier for longer. Access to good food, safe spaces, and medical care clearly mattered.

Researchers linked poor LE8 scores to more inflammation, higher blood sugar, and stiffening arteries. These small internal changes begin long before the first symptoms.

Once arteries lose flexibility, risk climbs even if lifestyle later improves. The earlier the damage begins, the harder it becomes to reverse.

Small changes prevent heart disease

Cardiovascular health builds from countless small actions. A walk after dinner, extra sleep, or less processed food can help protect blood vessels over time.

Young adults who improved their scores during the study saw real benefits. Those who moved from moderate to high heart health reduced their later disease risk significantly.

That finding gives hope. It proves heart health is not fixed. Habits in early adulthood can reshape the future.

“We hope that young adults will focus on their heart health as soon as possible, in order to gain the biggest dividends in longer, healthier lives,” said Dr. Lloyd-Jones.

The bigger picture

The study also revealed something deeper. Heart disease is not only about personal discipline. It reflects inequality.

People with fewer resources, less access to care, or limited education face harder odds. Improving national heart health means addressing these barriers along with promoting exercise and better diets.

Doctors could use LE8 assessments more widely for people under thirty. Tracking those numbers early can warn of decline long before illness begins. Preventive medicine should not wait until midlife. By then, much of the damage has already taken hold.

Start young, stay healthy

Cardiovascular disease grows quietly, often unnoticed until years later, but prevention speaks with undeniable power. The Boston University study proves that taking care of your heart early builds a kind of shield that lasts for decades.

People who maintain strong heart health in their twenties enjoy more years free from disease after forty-five, showing how small habits today can transform tomorrow’s outcomes.

Heart disease once carried an image of age and decline. That idea no longer fits. Prevention is now the business of the young.

The choices made in the rush of early adulthood – how much we move, what we eat, how well we sleep – echo through time. Your heart remembers those years vividly, holding on to every good or bad decision.

Building heart strength early is not complicated. It is consistent effort, not perfection, that protects. Even simple routines like walking daily, managing stress, or choosing real food over fast fixes create lifelong benefits.

Keeping your heart strong in your twenties might be the most powerful way to live longer, live better, and stay active in every decade that follows.

The study is published in the journal JAMA Network Open.

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