Glow Up to Grow Up: How Today’s Youth Must Embrace a Heart Healthy Lifestyle to Improve Longevity

Adolescence occurs between the ages of 10 and 19 years and is a critical life stage as children emerge into adults. As their bodies and minds continue to develop, individuals in this stage lay the foundations of health-related behaviors that will continue into adulthood. This period is defined by rapid physical, emotional, and psychosocial growth.⁽¹⁾ Today, adolescents mostly consist of members of the generation termed "Gen Z." In a current social media trend, older adults from around the world have taken to using Gen Z slang to describe topics that most adolescents probably find uninteresting. In that spirit, heart health is bussin, no cap, fam (i.e., cardiovascular health is seriously great). Yet, how can the American Heart Association (AHA) mitigate the growing cardiovascular disease (CVD) risk among emerging adults and how can this population become engaged in their heart health?

In their recent scientific statement, Dr. Jewel Scott and colleagues introduced the necessary components to achieve cardiovascular health during the critical adolescent and emerging adult life stages. They examine how population- and individual-level risk factors are becoming increasingly prevalent in this age group. According to an epidemiologic study of pooled American and Finnish cohorts, the age of about 17 years represents an inflection point at which the loss of cardiovascular health (CVH) accelerates significantly.⁽²⁾ Therefore, this life stage likely represents a unique window for preventive efforts that coincide with developmental and social transitions. For example, in a 2011 AHA Scientific Statement entitled, "Best Practices in Managing Transition to Adulthood for Adolescents With Congenital Heart Disease: The Transition Process and Medical and Psychosocial Issues," authors explored how a change of care from pediatric to adult practices should seamlessly maintain high-quality, developmentally appropriate services as a patient moves from adolescence to adulthood.⁽³⁾

As the Emerging Adulthood Statement details, the approach to developmentally appropriate and seamless prevention efforts can occur in different spheres. The clinical sphere is that in which physicians and other clinicians can target individual-level CVD risk factors. The societal sphere includes virtual and in-person interactions that create opportunities for policy-level oversight. Lastly, the intrapersonal sphere is perhaps the most challenging to address, but ultimately serves as the basis for adolescent's identity formation and future behavior.

Clinical Implications

As youth transition to adulthood, they reach developmental milestones that create the foundation upon which future health is built. Health behaviors such as daily physical activity and sufficient nightly sleep are part of AHA's 8 essential factors for achieving optimal CVH.⁽⁴⁾ Unhealthy habits like tobacco use, especially with electronic cigarettes, are more common among emerging adults today compared with 10-20 years ago.^{(5, 6)} Therefore, clinicians should assess their young patients' involvement in healthy lifestyle behaviors and encourage lifestyle modifications when indicated.

Risk assessment for the development of heart disease is critical in this stage. Unfortunately, as Scott and colleagues point out, most available risk calculators do not include lower age ranges for this patient population and therefore risk is often indeterminant. Currently, there is no consensus on when to begin screening for entities such as Cardio-Kidney-Metabolic (CKM) syndrome. However, according to epidemiologic data, stage 0 CKM was only present in 17% of young adults ages 20-44 years.⁽⁷⁾ In the event that elevated blood pressure, hyperlipidemia, obesity, or diabetes are detected, instituting evidence-based therapy will likely prevent further progression towards CVD or CKM. A growing body of research is exploring how best to test and treat young adults at elevated risk. In fact, a request from the National Heart, Lung, and Blood Institute is looking to fund a multi-site clinical trial to test and prevent CVD in young adults at elevated lifetime risk.⁽⁸⁾

Potential Policy Solutions

Because many youths are vulnerable to societal change, social factors may disproportionately affect this patient population, especially those who are from minoritized backgrounds. A patient-centered perspective should include solutions to address social determinants. Partnerships between clinicians, healthcare systems, professional societies, and government agencies can advocate for the requisite policy solutions.⁽⁹⁾ As one example for potential policy interventions, Scott suggests that the provision of preconception counseling and resources for adolescents as they approach childbearing age could address the growing number of adverse pregnancy-related cardiovascular outcomes.

Furthermore, policy-level interventions that specifically address social factors are being explored. Individuals approaching adulthood often experience increasing financial and social independence from caregivers, thus access to healthy behaviors and preventive care may create a financial burden for youth facing financial adversity. Policy level solutions include expanding health insurance coverage for adults up to age 26 years. For example, the Affordable Care Act facilitated increased access to preventive care. Yet, policies can also bring negative effects such as recently proposed changes to Medicaid coverage that would reverse access to preventive care for emerging adults.^(10-12)

Fostering Intrapersonal Wellness

In recognizing that adolescents are often sensitive to perceptions from peers, clinicians should be mindful that lifestyle interventions may not be utilized if they are viewed as socially undesirable.⁽¹³⁾ In today's increasingly technological society, mobile health (mHealth) advances have created possible opportunities for adolescents and young adults to achieve CVH by fostering healthy habits and mental wellness.⁽¹⁴⁾ Therefore mHealth interventions could become facilitators of future preventive interventions. Social media could also offer a platform for health and wellness interventions, but in their review of the available literature, Scott and colleagues found the success of social media interventions to be variable.

Social connectedness has been shown to mitigate the likelihood of developing heart disease in middle aged adults.⁽¹⁵⁾ Although the cardiovascular effects of interpersonal social networks on adolescents and young adults is less known, data suggest that friendships and relationships are of central importance to young people.^{(16, 17)} Societies such the World Health Organization have increased their focus on social connections across the lifespan in attempt to mitigate the adverse effects that disconnection can cause.⁽¹⁸⁾ Data show that there are 3.5 million young people in the United States who are not connected to educational or employment institutions.⁽¹⁹⁾ Unfortunately, young adults who are disconnected from society are probably less likely to engage with healthcare. Therefore, efforts to create intrapersonal wellness and psychological resilience within children and youth should begin early in life so that these foundations can be maintained throughout the lifespan.

Conclusions

In summary, screening for and addressing CVD risk in adolescents and emerging adults is critical during this life stage. The transitional period between adolescence and emerging adulthood requires comprehensive approaches across clinical, societal, and intrapersonal spheres. A focus on achieving health and wellness among our youth is reflective of a commitment to ensuring health equity for generations to come. Period.