Background: The American Heart Association recently defined 7 ideal health behaviors and factors that can be used to monitor ideal cardiovascular health (ICH) over time. These relate to smoking, physical activity, diet, body mass index (BMI), blood pressure, blood glucose and total cholesterol. Associations between repeated measures of ICH across the life-course with outcomes of subclinical atherosclerosis in adult life have not been reported.

Methods and Results: The sample comprised 1465 children and young adults aged 12 to 24 years (mean age 17.5 years) from the Cardiovascular Risk in Young Finns Study cohort. Participants were followed-up for 21years since baseline (1986) and had complete ICH data available at baseline and follow-up. Average lifetime ICH index was associated with reduced risk of coronary artery calcification (CAC) (P = 0.0004), high-risk carotid intima-media thickness (IMT) (P = 0.0005) and high-risk carotid distensibility (< 0.0001) in middle age. Participants with persistently low ICH status (lower than the median), as compared with persons with persistently high ICH status (higher than the median), had an increased risk of CAC (P = 0.02), high-risk IMT (P = 0.02), and high-risk distensibility (P < 0.0001). Participants who improved their ICH status from low to high did not have a different risk of CAC (P = 0.90), high-risk IMT (P = 0.25), or high-risk distensibility (P = 0.80) than participants who always had high ICH status.

Conclusions: The results show that ICH can be lost and regained, and importantly that regaining of ICH has a beneficial effect on cardiometabolic health. Health care providers should work to improve health behaviors especially in those who have lost ICH.