Adulting is hard on the heart: Teen to young adulthood is a critical time to address risk

(Press-News.org) Statement Highlights:

By age 18, many adolescents have already developed heart disease risk factors, such as high blood pressure, obesity, high cholesterol or Type 2 diabetes, and a growing number of younger adults are experiencing adverse cardiovascular events.   Numerous social determinants of health and developmental and life changes impact cardiovascular risk as young people progress from their teens to their mid-20s. The statement describes the challenges and opportunities for easing the transition from pediatric to adult medical care, and for creating effective interventions and health messages for emerging adults. Embargoed until 4:00 a.m. CT/5:00 a.m. ET Wednesday, March 26, 2025

DALLAS, March 26, 2025 — Many teenagers enter adulthood with significant risk factors for cardiovascular disease, and the transition from adolescence to adulthood is a key time to address these risk factors and reduce the risk of developing future cardiovascular disease, according to a new American Heart Association scientific statement published today in the Journal of the American Heart Association.

According to the scientific statement, “Cardiovascular Health in the Transition from Adolescence to Emerging Adulthood,” emerging adulthood is the period between age 18 and the mid- to late-twenties, when the brain and decision-making ability are still maturing to adult levels. Greater independence and many changes in life circumstances are occurring simultaneously during this time.

“Emerging adulthood is a time of significant planning, often centered around career development and forming close personal relationships. This pivotal phase is also an ideal time to establish health practices that support lifelong heart health,” said Chair of the scientific statement writing group Jewel Scott, Ph.D., R.N., FNP-C, an assistant professor of biobehavioral health and nursing science in the College of Nursing at the University of South Carolina in Columbia, South Carolina.

The scientific statement reviews many of the individual and social challenges to protecting heart health in emerging adults, and it identifies types of interventions that may help.

Transitions in health care and lifestyle changes

In childhood and adolescence, there are typically standard occasions to see health care professionals, such as scheduled vaccinations and school or sports check-ups. These visits provide an opportunity to measure weight and blood pressure and check cholesterol and blood sugar levels. They can also open the door to a discussion about maintaining heart health and addressing any concerns before a risk factor is apparent.

“In the transition from high school to young adulthood, the built-in checkpoints fall off, and young adults may not reengage with care until after they’ve developed a heart disease risk factor,” said Scott.

Life’s Essential 8, the American Heart Association’s key measures for improving and maintaining cardiovascular health, include several health behaviors (such as eating a healthy diet and getting enough physical activity) that may worsen in emerging adulthood. This period of life usually brings greater responsibilities along with a loss of structures that were in place during adolescence. Becoming more sedentary is common, as is gaining weight.

“Lots of youth who were very active in high school become less active once the recreational sport or team sport they loved goes away. How to cook is not often taught in high school these days, and we know that people who have more cooking skills are more likely to prepare food at home — and meals at home tend to have less sodium and to be more balanced than meals at fast food or sit-down restaurants,” said Scott.

Responsibilities related to school, work, commuting and parenting may also make it difficult for young adults to get sufficient sleep, another important factor for optimal heart health.

While, historically, young people often started smoking tobacco in middle school and high school, the percentage of people who started using tobacco between 18 and 23 years of age doubled between 2002 to 2018, with electronic cigarettes as the most frequently used product. The authors emphasize that more research is needed to learn about the long-term cardiovascular effects of vaping.

Barriers to health care access

The ability to pay for health care may also become a challenge during the transition from adolescence to adulthood. Emerging adults make up the largest group of the 27 million uninsured adults in the United States. In some states without expanded Medicaid access, individuals can lose their Medicaid coverage when they turn 19. If their parents are insured through the Affordable Care Act, emerging adults age out of coverage after age 26.

While college health services can be important in providing care, 40% of all college students attend two-year community colleges. These students are less likely to have access to health care, which is often not available at community colleges. Young adults pursuing a trade pathway or apprenticeship are also less likely to have health insurance coverage.

To improve health care access for emerging adults, the statement suggests supporting policies that expand insurance access across the lifespan and eliminate gaps in coverage. However, the statement points out that barriers to obtaining health care go beyond insurance status, since health care utilization is less than 40% among insured emerging adults. Barriers may include a lack of knowledge of health care services, past negative experiences with care or other issues, such as long wait times and poorly coordinated care.

Other social determinants of health

Social determinants of health have a significant impact on cardiovascular health outcomes during emerging adulthood. Factors such as education, neighborhood environment and economic stability play a crucial role in mediating health inequities:

Higher education is strongly correlated with better cardiovascular health. Principles of cardiovascular health should be integrated into educational settings from early in life and continue through post-secondary and vocational education. Neighborhoods that are segregated, have fewer resources, have less access to clean air and water and lack safe spaces for physical activity, are associated with poorer cardiovascular health beginning at a young age. The statement advocates for policies addressing social and economic inequities that contribute to residential segregation, and for greater access to and utilization of green spaces and safe spaces for physical activity. As friendships and intimate partner relationships become more central in the lives of emerging adults, a lack of positive social connection and support is related to poorer cardiovascular health. Enhancing peer relationships and social networks could have a positive impact on heart-related behaviors in young adults, such as promoting tobacco cessation or encouraging more physical activity. The statement calls for exploring opportunities to reduce isolation, especially for those who may have experienced serious isolation during the COVID-19 pandemic, and to identify and intervene with at-risk individuals, such as those with a history of intimate partner violence, adverse childhood experiences or social isolation. Economic instability creates barriers to health care access and nutritious foods. The statement calls for supporting policies that remove financial barriers to health care, identifying disconnected young people — those not employed or pursuing further education — and designing programs to promote vocational training and improve financial stability. “We highlight some of the populations that need extra effort or attention tailored to their unique circumstances, such as those moving out of the foster care system and others who have barriers engaging with the health care system. One size may seem to fit all, however, it doesn’t usually work,” said Scott.

Opportunities for engagement

When young adults visit their health care professionals, there may be missed opportunities to discuss how to protect heart health.

“Clinicians have limited time with each patient. We may see their blood pressure is a little high, but we don’t address it because they came in with an ear infection or sprained ankle or something else that needs immediate attention. We may miss the opportunity to let them know that they are in the elevated blood pressure range and ways they can take action. We need to have these conversations and make sure that heart health is at the front of their minds,” said Scott.

Health care engagement also provides an important opportunity to address cardiovascular health before pregnancy, since suboptimal cardiovascular health increases the risk of adverse pregnancy outcomes, such as gestational diabetes, preeclampsia and pre-term birth. Adverse pregnancy outcomes are strongly associated with poorer cardiovascular health later in life.

The statement also suggests leveraging telehealth and mobile technology to increase health care use among emerging adults. With young adults increasingly living in a digital world, there is a need to explore how social media can be harnessed to deliver tailored cardiovascular prevention messages and track whether they are effective in resulting in behavioral changes.

In addition, researchers, clinicians and the public health community are encouraged to think about other avenues for reaching emerging adults, such as community colleges and universities, the military and veterans administration, and industries such as hospitality that employ a disproportionate number of young adults.

This scientific statement was prepared by the volunteer writing group on behalf of the American Heart Association Prevention Science Committee of the Council on Epidemiology and Prevention and the Council on Cardiovascular and Stroke Nursing; the Council on Lifelong Congenital Heart Disease and Heart Health in the Young; and the Council on Lifestyle and Cardiometabolic Health. American Heart Association scientific statements promote greater awareness about cardiovascular diseases and stroke issues and help facilitate informed health care decisions. Scientific statements outline what is currently known about a topic and what areas need additional research. While scientific statements inform the development of guidelines, they do not make treatment recommendations. American Heart Association guidelines provide the Association’s official clinical practice recommendations.

Co-authors are Vice Chair Anandita Agarwala, M.D.; Carissa M. Baker-Smith, M.D., M.P.H., FAHA; Matthew J. Feinstein, M.D., M.Sc., FAHA; Karen Jakubowski, Ph.D.; Jill Kaar, Ph.D., FAHA; Niyati Parekh, Ph.D., M.S., R.D., FAHA; Kershaw V. Patel, M.D.; and Janna Stephens, Ph.D., R.N. Authors’ disclosures are listed in the manuscript.

The Association receives more than 85% of its revenue from sources other than corporations. These sources include contributions from individuals, foundations and estates, as well as investment earnings and revenue from the sale of our educational materials. Corporations (including pharmaceutical, device manufacturers and other companies) also make donations to the Association. The Association has strict policies to prevent any donations from influencing its science content. Overall financial information is available here.

Additional Resources:

Available multimedia is on right column of release link After March 26, 2025, view the manuscript online. AHA Scientific Statement news release: Primary care professionals key to helping people achieve & maintain heart health (Nov. 2024) AHA Presidential Advisory: Forecasting the Burden of Cardiovascular Disease and Stroke in the United States Through 2050—Prevalence of Risk Factors and Disease (June 2024) AHA news release: Women with excess weight as a teen or young adult may have higher stroke risk by age 55 (June 2024) AHA news release: Young adults with migraine, other nontraditional risk factors may have higher stroke risk (March 2024) AHA Scientific Statement news release: Current evidence identifies health risks of e-cigarette use, long-term research needed (July 2023) AHA news release: Erratic sleep patterns linked to elevated blood pressure in teens with extra belly weight (March 2023) AHA Scientific Statement news release: Does risk for heart disease start before birth? (Feb. 2023) AHA Scientific Statement news release: Action needed to reduce e-cigarette use among adolescents to lower lifetime CVD risk (June 2022) AHA Scientific Statement news release: Healthy eating behaviors in childhood may reduce the risk of adult obesity and heart disease (May 2020) Follow AHA/ASA news on X @HeartNews Follow news from the Journal of the American Heart Association @JAHA_AHA ###

About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. Dedicated to ensuring equitable health in all communities, the organization has been a leading source of health information for more than one hundred years. Supported by more than 35 million volunteers globally, we fund groundbreaking research, advocate for the public’s health, and provide critical resources to save and improve lives affected by cardiovascular disease and stroke. By driving breakthroughs and implementing proven solutions in science, policy, and care, we work tirelessly to advance health and transform lives every day. Connect with us on heart.org, Facebook, X or by calling 1-800-AHA-USA1

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