Most Adults Already Have Heart Disease Risk Factors by Their Early 20s, New Study Finds

Heart disease is supposed to be an old person’s problem. It’s a common assumption in early adulthood, the kind that excuses late nights, fast food, and skipped workouts under the comfortable logic that there’s plenty of time to get healthy later. A new study suggests that assumption may be dangerously wrong.

Researchers examined more than 1,200 young adults with an average age of just 22.9 years in a study published in the journal Circulation: Population Health and Outcomes. Roughly 80% were already classified in some stage of cardiovascular-kidney-metabolic syndrome, a spectrum that ranges from excess body fat to metabolic risk factors and, in a much smaller group, early subclinical disease. And the young adults with more advanced staging were already showing greater evidence of early injury to their arteries, the kind of change linked to heart attacks and strokes in older adults. By their early twenties, for participants further along that spectrum, the warning signs were already measurable.

This research is part of the FF-CHAYA study, short for Future of Families–Cardiovascular Health Among Young Adults, which drew participants from large cities across the United States. Participants were part of a longer-running project that originally enrolled mothers and newborns between 1998 and 2000, deliberately including high proportions of people from lower-income households and from Black and Hispanic communities. The results offer a worrying look at heart health among the country’s next generation of adults.

What Is CKM Syndrome, and Why Does It Matter at 22?

In 2023, the American Heart Association introduced a framework called Cardiovascular-Kidney-Metabolic Syndrome, or CKM Syndrome, to describe how problems with excess body weight, metabolism, and kidney function are deeply connected and together drive heart disease risk. CKM is organized into stages: Stage 0 means no risk factors; Stage 1 involves excess body fat; Stage 2 adds metabolic problems like high blood pressure or abnormal cholesterol; Stage 3 includes early signs of disease detectable by imaging or advanced kidney dysfunction.

Until this study, little was known about how this framework applied to people in their early twenties. Most CKM research had focused on middle-aged or older adults. Researchers wanted to find out whether the staging system was meaningful for younger people, and whether it correlated with actual, measurable signs of physical damage to the arteries.

How the Study Was Conducted

Between 2021 and 2023, researchers conducted in-person medical examinations of 1,283 young adults, all around age 23. Participants underwent physical measurements including blood pressure, body size, and blood tests for cholesterol, blood sugar, and kidney function. They also completed questionnaires about their diet, sleep habits, physical activity, and tobacco use.

Each participant received an ultrasound scan of the carotid arteries, the major blood vessels running up each side of the neck that supply blood to the brain. Measuring the thickness of the inner wall of those arteries, known as carotid intima-media thickness (cIMT), is a well-established way to detect early arterial injury before cardiovascular disease becomes clinically apparent.

Researchers then sorted participants into CKM stages and compared artery measurements and overall heart health scores across groups. Heart health was scored using a tool called Life’s Essential 8, which grades eight factors (diet, physical activity, sleep, nicotine exposure, body weight, blood sugar, cholesterol, and blood pressure) on a scale of 0 to 100, with higher scores meaning better health.

Among the 1,283 participants, just over half (54.4%) were women. By race and ethnicity, 51.6% identified as Black, 27.1% as Hispanic, 16.8% as White, and 4.4% as another group. More than half had experienced parental incarceration, and the large majority came from households that were at or below moderate income levels at the time of their birth.

What the Artery Scans Revealed About CKM Syndrome in Young Adults

Only 20.7% of participants were classified as Stage 0, meaning they had no CKM risk factors. About 40% were in Stage 1, indicating excess body fat. Another 36.2% were in Stage 2, with additional metabolic problems such as elevated blood pressure or cholesterol. And 2.8% were already in Stage 3, with detectable signs of early cardiovascular or advanced kidney disease, at an average age of 23.

Overall heart health scores declined as CKM stage advanced. Those in Stage 0 scored an average of 77.6 out of 100 on the Life’s Essential 8 measure. Participants in Stage 1 scored about 7.6 points lower on average. Those in Stages 2 and 3 scored roughly 13 to 14 points lower than the Stage 0 group. Diet and physical activity scores fell below 50 out of 100 at every CKM stage, even among those with no other risk factors.

On the artery scans, participants with more advanced CKM stages showed measurably thicker artery walls. Compared with Stage 0 participants, those in Stage 3 had artery walls that were, on average, 0.100 millimeters thicker, as measured by mean-maximum carotid intima-medial thickness. While that might sound tiny, prior research has found that even small differences of this magnitude in artery wall thickness in older adults are linked to significantly higher risk of heart attack and stroke. In young adults, researchers noted, those associations may be even more consequential over a lifetime. Because participants were measured only once, though, this study could not show what those differences will mean for any individual’s future risk.

Most sobering is the age at which these changes show up. Prior research has linked excess body fat in early life to thicker artery walls in adulthood, but studies that actually measure those changes in people in their early twenties are rare. This study shows that measurable differences in artery health can already be detected in some young adults in their early twenties by the time many are finishing college.

Researchers noted that the differences in artery thickness they found would be considered advanced relative to participants’ ages. The study cohort was specifically designed to include people from disadvantaged backgrounds, a group that faces a disproportionate burden of the very conditions driving CKM Syndrome. Projections cited in the paper suggest that obesity, diabetes, and high blood pressure will rise sharply among adults aged 20 to 44 in the coming decades, with minoritized groups bearing the greatest burden.

Those low diet and activity scores likely reflect both real behaviors and the limits of self-reported data, the authors note. Either way, there is clearly meaningful room to improve heart-healthy habits well before any chronic condition develops.

Waiting until middle age to address heart disease risk is no longer a defensible strategy, at least not for the population this study examined. In this cohort, roughly four out of five young adults were already in Stage 1 or higher CKM, and those with more advanced stages showed greater evidence of early arterial injury. The evidence makes a strong case that prevention efforts need to start much earlier and reach much further upstream.

Disclaimer: This article summarizes findings from a single peer-reviewed study and is intended for general informational purposes only. It is not medical advice. The research was cross-sectional, meaning it captured data at one point in time and cannot establish cause and effect or predict any individual’s future risk of heart attack or stroke. The study also drew from a group intentionally enriched for participants from disadvantaged urban backgrounds, so the results may not represent all young adults. Anyone with questions about their personal heart health should consult a qualified healthcare provider.

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