Abstract 4146692: Cardiovascular Health Declines During Young Adulthood – An Electronic Health Record Study of >75,000,000 Individuals

Background: Young adulthood (YA, 19–39 years) is the life stage of greatest increase in cardiovascular (CV) risk and decline in CV health (CVH). Cosmos is a database of Electronic Health Record (EHR) data from all Epic EHR sites – including >250 million patients. Previous observations of CVH in YA have been limited to small, epidemiological cohort studies. Purpose: The current study aimed to be the first to use Cosmos to describe CVH in a nationally representative, extremely large, cohort of YAs. Methods: The AHA Life’s Essential 8 framework for CVH includes target metrics for health behaviors (nicotine exposure, diet, physical activity (PA), and sleep) and clinical factors (BMI, non-HDL-C, glucose, and blood pressure (BP)). We aimed to trend the proportion meeting “ideal” (highest score) for available CVH metrics (smoking, systolic BP (SBP), non-HDL, BMI, hemoglobin A1c, PA) across the young adulthood (from 19 to 39 years), by extracting available Cosmos data spanning May, 2022 to April, 2024. Results: The total sample included 76,216,126 YA (54% White, 15% Black, 4% Asian, 14% Hispanic; 54% female) of age 19-39 years. CVH available data varied: 2, 3.5, and 4.3 million for non-HDL, PA, and A1c, respectively; 28.8, 47.8, and 66.6 million for BMI, SBP, and smoking, respectively. Overall, ideal CVH metrics were more common than poor (Table), except for BMI. However, prevalence of ideal CVH decreased with increasing age (Figure). A notable exception was the proportion reporting PA 6+ days/week, which was low and stable by age. Additional analysis showed a greater proportion reported PA 4+ (vs. 6+) days/week, potentially increasing by age (34.2% at 22-24y, ~42% at 31-39y, 44.6% at 19-21y). Conclusion: Among the largest group of YAs ever assessed, we found persistent declines in most CVH metrics with age. Within the context of analyses from much smaller cohorts, these findings support investigating interventions to effectively stem the decline in CVH in this at-risk group.