Artery injury is already showing up in adults in their 20s

Clinical takeaway: Consider cardiovascular-kidney-metabolic (CKM) health and Life’s Essential 8 metrics when counseling patients in their 20s, even when short-term cardiovascular risk appears low; excess adiposity and metabolic risk factors may already coincide with subclinical arterial injury.

Cardiovascular risk may begin translating into measurable vascular damage decades before clinical events, supporting earlier assessment and prevention efforts in young adults.

In a cross-sectional study of 1,283 US young adults with an average age of 23, 79.2% met criteria for CKM syndrome stages 1 through 3. About 40% were at stage 1, reflecting excess or dysfunctional adiposity; 36% were at stage 2, indicating metabolic or kidney risk factors; and 2.8% were at stage 3, reflecting subclinical cardiovascular disease or high-risk equivalents. Only 20.7% had no identifiable CKM risk factors.

Cardiovascular health also worsened as CKM stage advanced. Adjusted Life’s Essential 8 scores fell from 77.6 points at stage 0 to about 64 points at stages 2 and 3, with differences driven largely by BMI, lipids, blood pressure, and glycemia rather than measured health behaviors.

Carotid ultrasound showed a parallel gradient in early vascular injury. Mean-maximum carotid intima-media thickness increased from 0.622 mm at stage 0 to 0.637 mm at stage 1, 0.649 mm at stage 2, and 0.72 mm at stage 3; other ultrasound measures also suggested greater arterial injury with advancing CKM stage.

“The study shows that CKM syndrome staging and Life’s Essential 8 are complementary for identifying adults younger than age 30 who may be on the fast track for arterial injury,” study author Donald Lloyd-Jones, MD, ScM, said in an American Heart Association news release.

The authors caution that the study cannot establish causality and that the cohort oversampled people from disadvantaged backgrounds, potentially limiting generalizability. Still, they conclude that prevention may need to start substantially earlier in the life course.

Source: Krishnan V, et al. (2026 Aug 20) Circ Popul Health Outcomes. Association Between Cardiovascular-Kidney-Metabolic Health and Early Arterial Injury in Young Adults in the United States: The Future of Families–Cardiovascular Health Among Young Adults Study