Young adults in the United States carry an increasing burden of heart health risk factors, making it more likely they'll suffer a heart attack and stroke as they age, a new study warns.
More adults ages 20 to 44 are obese and diabetic than a decade ago, and they are more likely to have poorly controlled blood pressure, according to the study published March 5 in the Journal of the American Medical Association.
Researchers also found that young Black and Hispanic adults are more likely to suffer from these risk factors than white young adults.
“We're witnessing a smoldering public health crisis,” said senior researcher Dr. Rishi Wadhera, section head of health policy and equity at Beth Israel Deaconess Medical Center's Smith Center for Outcomes Research in Boston.
“The onset of these risk factors earlier in life is associated with a higher lifetime risk of heart disease and potentially life-threatening cardiovascular conditions, like a heart attack or stroke,” Wadhera continued. “Our finding that the burden of many cardiovascular risk factors is rising in young adults could have major public health implications over the long-term, especially as the U.S. population ages.”
These health problems in people so young are likely contributing to declining life expectancy in the United States, said Norrina Allen, director of the Institute for Public Health and Medicine at Northwestern University Feinberg School of Medicine in Chicago.
“It's shocking to me that this generation is the first that has a shorter life expectancy than we currently do,” said Allen, who co-authored an editorial accompanying the new study. “And I really hope that we can prioritize the health of our children and young adults in order to prevent the growing burden of heart disease.”
For the study, Wadhera and his colleagues analyzed more than a decade's worth of federal survey data related to health and nutrition in the United States.
They found that obesity rates among adults 20 to 44 rose from about 33% in in 2009-2010 to 41% in 2017-2020. Likewise, the prevalence of diabetes rose from 3% to just over 4%.
Rates of high blood pressure also increased from more than 9% in 2009-2010 to almost 12% in 2017-2020, but many young adults with high blood pressure and diabetes aren't doing anything to control these conditions, Wadhera said.
“Medical treatment rates for high blood pressure and diabetes were surprising low,” Wadhera said. “Only approximately 55% of young adults with hypertension were receiving blood pressure medications, and just 1 in 2 young adults with diabetes were on treatment.”
The researchers found trends among Black and Hispanic adults particularly troubling.
Young Black adults experience the highest premature heart-related death rates in the nation, and here they were more than two times more likely to have high blood pressure than any other group, Wadhera said.
Diabetes and obesity also were far more common in younger Black and Hispanic Americans, researchers found.
And among young Hispanic adults, rates of high blood pressure more than doubled from about 4% to nearly 11%, Wadhera said.
Young people feel invincible
Part of the problem is the invincibility of youth, experts said.
“I think younger individuals don't comprehend that they are at risk for some of this,” said Dr. Jeffrey Berger, a cardiologist with NYU Langone Medical Center in New York City. “You think you're a little bit more like Superman or Superwoman, where nothing will affect you.”
Because they feel invincible, younger adults are less likely to have health insurance and seek regular medical care, Allen said.
“When you're a young adult, I think heart disease or stroke and the outcomes of those risk factors feels like a long way off, because most of those events are happening later in life,” Allen said. “To be honest, they are the group with the lowest health care coverage, insurance coverage, and so continuity of health care and having a primary care provider who is going to monitor and manage their risk factors is poor, unfortunately, in that age group.”
Because they aren't regularly seeing a doctor, many young adults aren't aware that they have these risk factors, Wadhera noted.
“If you don't know that you have diabetes, for example, it's hard to treat it,” Wadhera said.
The disparities found among Black and Hispanic adults likely stem from larger societal inequities, experts said.
“We know that income inequality and inability to access healthy food and inability to afford medications consistently, all of that plays a role in how well we can prevent and how well we can control things like hypertension and diabetes,” Allen said. “And unfortunately, we see that the rates of control, even once people have those, is very low.”
“Younger Black individuals are more likely to live in lower-income households that experience housing instability and food insecurity, as well as in socioeconomically disadvantaged neighborhoods, which often have less green space for regular exercise and more exposure to environmental stressors such as air pollution,” Wadhera added. “Black individuals also disproportionately face challenges accessing primary and preventive care.”
The study did contain one bit of good news -- rates of high cholesterol among young adults decreased from almost 41% to 36%, researchers report.
Wadhera and his colleagues speculated that this is due to the government crackdown on the use of trans fats and partially hydrogenated oils in processed foods and fast food.
Know your numbers
Young adults can start controlling their risk factors by going to the doctor and finding out where their health stands, Allen said.
“The first important thing is knowing your numbers -- knowing what your blood pressure is, knowing what your cholesterol is, making sure you're checking your weight regularly,” Allen said.
People with risk factors like elevated cholesterol, high blood pressure and diabetes can start taking medication to control them, Berger said, and adopt a healthier lifestyle.
“I think we really need to just get people on some therapy,” Berger said. “We need to remind all of ourselves the importance of lifestyle, healthy eating and physical activity. It just sort of really reminds us of how much work there is to be done.”
“Any change is good change,” Allen said, “You don't have to change everything at once. You can pick one aspect that you want to start improving, whether you're going to get out and walk for 20, 30 minutes every day or you're going to try and reduce the amount of packaged snacks or sodas that you drink. Even those small changes can add up to major differences in the long term.”
Wadhera also presented these findings this week at the annual meeting of the American College of Cardiology, in New Orleans.
The U.S. Centers for Disease Control and Prevention has more about risk factors for heart disease.
SOURCES: Rishi Wadhera, MD, section head, health policy and equity, Beth Israel Deaconess Medical Center's Smith Center for Outcomes Research, Boston; Norrina Allen, PhD, director, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; Jeffrey Berger, MD, cardiologist, NYU Langone Medical Center, New York City; Journal of the American Medical Association, March 5, 2023