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BOSTON — When it comes to heart health, waiting until adulthood to make changes may be waiting too long. New research identifies a crucial turning point in children’s cardiovascular health — around age 10 — when healthy habits begin to decline, potentially setting the stage for future heart problems.
The study paints a concerning picture of youth cardiovascular health in America. An analysis of national data shows that optimal heart health is remarkably rare among young people, found in just one in 50 children and teenagers. Even more worrying, more than two-thirds of children don’t achieve what doctors would consider “high” cardiovascular health scores.
These statistics underscore the urgency of understanding how and when heart health begins to decline in young people. Even more concerning is that cardiovascular disease remains a critical public health concern, with risk factors such as high blood pressure, abnormal blood sugar levels, elevated cholesterol, and obesity beginning in childhood.
“Though we know that better heart health in childhood is linked to lower risks of coronary issues later in life, the current state of cardiovascular health in US children is less than ideal,” says lead author Izzuddin Aris, a Harvard Medical School assistant professor of population medicine at the Harvard Pilgrim Health Care Institute, in a statement.
The research, published in JAMA Cardiology, tracked over 1,500 children from early childhood through late adolescence, painting a comprehensive picture of how cardiovascular health evolves during these formative years. The findings reveal that while children generally maintain good heart health through their early years, there’s a notable decline that begins around age 10, marking a critical juncture for intervention.
This pivot point occurs as children transition between childhood and adolescence – a time when many kids start making more independent lifestyle choices about diet, physical activity, and sleep habits. The study found that boys showed a faster initial improvement in cardiovascular health before age 10 but also experienced a steeper decline afterward compared to girls.
To evaluate cardiovascular health, researchers used the American Heart Association’s recently introduced “Life’s Essential 8” framework. This comprehensive assessment looks at eight key factors: diet quality, physical activity, nicotine exposure, sleep duration, body mass index, blood pressure, blood glucose, and cholesterol. Think of it as a report card for heart health, with scores ranging from 0 to 100.
The numbers tell an important story: The average cardiovascular health score started at 82.6 in early childhood (around age 3), peaked at 84.1 in middle childhood (around age 7), then began declining to 82.0 in early adolescence (around age 13), before dropping more sharply to 73.8 in late adolescence (around age 17). This decline, occurring around age 10 across all demographic groups, may reflect social and developmental changes typical of this age – such as changes in school schedules that can interfere with healthy sleep patterns and dietary habits.
Particularly noteworthy was the finding that behavioral factors – like diet, physical activity, and sleep – drove the decline more than biological factors such as blood pressure or cholesterol levels. This suggests that lifestyle choices play a crucial role in cardiovascular health trajectories.
The study also uncovered important disparities in cardiovascular health patterns. Children from families with lower household incomes or whose mothers had less education showed lower cardiovascular health scores throughout childhood. Similarly, non-Hispanic Black children and children of other non-Hispanic races showed different patterns in their health trajectories compared to non-Hispanic White children.
“Our study highlights the potential early influence of structural factors linked to socioeconomic status and race and ethnicity—such as residence in favorable neighborhood environments, the ability to access healthy foods, and proximity to safe community spaces that encourage physical activity—that might contribute to future cardiovascular health disparities,” adds Dr. Aris.
These findings have significant implications for public health strategies. Rather than waiting until adulthood to address cardiovascular health, the research suggests that interventions should begin in early childhood, with particular attention paid to the crucial period around age 10. This might include school-based programs promoting healthy eating and physical activity, family education about sleep habits, and community initiatives supporting healthy lifestyle choices.
The study’s breadth is impressive, following children from as young as 2.8 years-old up to 20.1 years of age, with regular check-ins to assess their cardiovascular health. This long-term approach provides a unique window into how heart health evolves during crucial developmental periods.
“Our study provides insight into the trajectory of cardiovascular health in early life, establishing a clear window of opportunity to improve the health of the nation’s children now and into the future,” says Dr. Aris.
This research not only isolates the most vulnerable age for cardiovascular health loss but can also help improve the targeting of preventive efforts to high-risk children while enhancing our understanding of the early life drivers of cardiovascular health decline.
What makes these findings particularly compelling is their practical applicability. Unlike genetic factors or other unchangeable characteristics, behavioral factors can be modified through targeted interventions. This offers hope that with the right support and timing, we can help children maintain better cardiovascular health as they grow.
The findings establish a critical foundation for understanding how cardiovascular health develops – and potentially deteriorates – during childhood. Perhaps most importantly, the study highlights that heart health isn’t just an adult concern – it’s a lifetime journey that begins in childhood. The choices and habits formed during these early years can set the stage for cardiovascular health throughout life.
Paper Summary
Methodology
The researchers used data from Project Viva, a pre-birth cohort study in eastern Massachusetts that began recruiting pregnant women between 1999 and 2002. They followed 1,523 children, collecting data at four key life stages: early childhood (median age 3.2 years), middle childhood (median age 7.7 years), early adolescence (median age 13.0 years), and late adolescence (median age 17.5 years).
To be included in the study, children needed to have information on at least 3 cardiovascular health metrics in early childhood or at least 4 metrics in the later stages. In early childhood, researchers assessed 6 metrics (diet, smoking exposure, physical activity, sleep duration, BMI, and blood pressure), expanding to 8 metrics in later stages by adding blood glucose and cholesterol measurements.
Key Results
The study identified a clear inflection point around age 10 when cardiovascular health began to decline across all demographic groups. Boys showed both faster improvement before this point and a steeper decline afterward compared to girls. The mean age of inflection was 10.1 years for male children and 10.0 years for female children.
Children from lower-income families and those whose mothers had less education consistently showed lower cardiovascular health scores. Importantly, the decline in health was primarily driven by behavioral factors rather than biological ones, suggesting that lifestyle interventions could be particularly effective.
Study Limitations
Researchers relied partly on self-reported or parent-reported information for factors like physical activity and sleep, which might not be as accurate as objective measurements. The participant group was primarily from eastern Massachusetts and had higher overall cardiovascular health than the general U.S. child population, potentially limiting the findings’ broader applicability. Additionally, about 28% of the original cohort was excluded from the analysis, and these children were more likely to be from lower socioeconomic status families.
Discussion & Takeaways
The study provides crucial evidence that cardiovascular health interventions should begin early in life, with particular attention to the period around age 10. The findings suggest that focusing on behavioral factors like diet, physical activity, and sleep might be more effective than focusing solely on biological factors. The research also highlights the need to address socioeconomic and racial disparities in childhood cardiovascular health, particularly through structural changes that affect access to healthy foods and safe spaces for physical activity.
Funding & Disclosures
Project Viva is supported by grants from the National Institutes of Health. The current study received additional funding from the National Institutes of Health and the American Heart Association. The researchers reported no conflicts of interest.
Publication Details
This research was published in JAMA Cardiology on December 18, 2024. The paper, titled “Trajectory of Cardiovascular Health Across Childhood and Adolescence,” can be found using its Digital Object Identifier (DOI): 10.1001/jamacardio.2024.4022. JAMA Cardiology is part of the JAMA Network family of medical journals, which are peer-reviewed publications known for their rigorous scientific standards.
