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Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

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1. The Healthy Heart Score (HHS), a tool normally used in older populations to predict the risk of atherosclerotic cardiovascular events, was moderately successful in assessing risk of premature cardiovascular events for young adults aged 18 to 30.

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2. The HHS tool performed better in men, white participants, and in those without clinical risk factors at baseline.

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Evidence Rating Level: 2 (Good)

Study Rundown:

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With increasing cardiovascular risk factor prevalence among younger adults, it is important to be able to assess the risk of premature atherosclerotic cardiovascular disease (ASCVD) in this population. However, few tools are successful at doing this. This prospective cohort study aimed to assess the performance of the Healthy Heart Score (HHS) to determine its ability to discern ASCVD events in adults aged 55 and below.

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Overall, the HHS performed moderately well in discerning risk of ASCVD in young, healthy adults aged 18 to 30, with a corresponding C-statistic of 0.71 in all adults. The HHS performed better in males, white participants, and those without clinical cardiovascular risk factors (dyslipidemia, hypertension or diabetes type 1 or 2) at baseline. This study used an existing risk stratification model with over 25 years of follow-up to assess ASCVD risk in young adults and had a large sample size, however it was based on a study sample from the 1980s where there may be lower prevalence of baseline clinical risk factors compared to present day prevalence in young adults.

In-Depth [prospective cohort]:

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The Coronary Artery Risk Development in Young Adults (CARDIA) prospective cohort study was conducted from 1985 through to 2013 using baseline data of young adults aged 18-30 from 4 sites in the USA. Baseline clinical and lifestyle factors were gathered and the sample was followed every 6 months for medical events. They were followed for a median of 27.1 years (IQR 26.9-27.2). The exposure of interest was application of the HHS to determine the outcome of its ability to assess 25-year risk of ASCVD (death from coronary heart disease, nonfatal myocardial infarction, fatal or nonfatal ischemic stroke) in the total sample. The HHS was originally made in 1986 to estimate ASCVD events in older adults, and included age and self-reported smoking status, BMI, alcohol intake, exercise and diet. Statistical analysis included model discrimination with the Harrell C statistic.

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A total of 4893 participants were included in the CARDIA study, of which 45.1% were male, the mean age was 24.8 years, and 8.7% had at least 1 clinical ASCVD risk factor (dyslipidemia, hypertension or diabetes type 1 or 2). Through follow-up there were 64 premature ASCVD events. The HHS showed moderate discrimination for CVD risk in the overall population (C statistic 0.71; 95%CI 0.66-0.76). It performed better in men (C statistic 0.74; 95%CI 0.68-0.79), white participants (C statistic 0.77; 95%CI 0.71-0.84), and those without baseline clinical CVD risk factors (C statistic 0.71; 95%CI 0.66-0.76).

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