2025 AHA科学声明：从青春期过渡到成年初期的心血管健康

其他心血管内科· 心脏康复与其他 · 2025

CVD Prevention

Primary prevention seeks to intervene before disease onset in developmentally appropriate ways (Table 3 ). Although recent findings from a school-based CVH promotion intervention were disappointing, the potential for population-level improvements is worth further attempts to incorporate school-based interventions as part of broader ecologic approaches that include policy change. 106 Studies also suggest that interventions focused on improving food and nutrition literacy combined with enhancing cooking skills during the transition to adulthood are valuable and may have long-term benefits for nutrition. 107 Many adolescents and emerging adults may be unaware that unhealthy weight control behaviors such as dieting promote cycles of weight loss and weight regain. 108, 109 Expectation management for body shape and size, self-acceptance of diverse body shapes, emphasis on diet quality, and discouraging restrictive weight control behaviors are important interventions.

114 Applications such as MyFitnessPal, CalorieKing, Fitbit, MySugr, Glucose Buddy, and Lose It! have been prescribed by physicians. 115 However, data regarding the usability and effectiveness of these applications, independent of clinician input, have been questioned, and there are economic disparities in access to wearable health devices. 116, 117 Moreover, as mentioned above, the EARLY trials incorporated technology with varying degrees of success, raising questions about its utility for this population. 95 However, today's emerging adults have been immersed in the Internet throughout their lives, and these technologies could ultimately serve as a valuable tool to enhance the health care infrastructure. 118 dditionally, few avenues or platforms are more ubiquitous for reaching emerging adults than social media. Future research may engage dissemination and implementation science to explore innovative methods to harness the power of social media for health communication. For example, some research suggests that social media influencers can have a positive impact on the physical activity motivations of their followers, and during the COVID-19 pandemic, the potential of social media influencers as health communicators was evident. 119, 120 In addition, researchers, clinicians, and the public health community will need to think creatively about other avenues for reaching emerging adults, such as minority-serving institutions (eg, historically Black colleges and universities), 121 the military and Veterans Affairs, and industries that employ a disproportionate number of emerging adults such as hospitality.

Considering the transition from pediatric to adult care, a study of young adults with familial hypercholesterolemia and their parents identified several key challenges during this transition, including recognizing oneself as a decision-maker, prioritizing treatment for a chronic condition with limited external symptoms, managing social implications of their condition, and finding credible resources and guidance. 143 ealth care practices jointly staffed by pediatric and adult clinicians, as well as enhanced after-hours support, are examples of interventions that may ease the transition. 144 More broadly, supporting the transition to adulthood should be expanded to help eligible emerging adults understand how to sign up for Supplemental Nutrition Assistance Program benefits, navigate insurance coverage issues, and other life skills that some of the most vulnerable youth may need. For example, a community advisory board guided the development of a health insurance and financial toolkit for emerging adults with type 1 diabetes. 145 These types of supports are needed for other populations, such as the 23 000 emerging adults who age out of foster care each year or the 4.4 million disconnected youth (Figure 3 ). 146

CONCLUSIONS

Efforts to reduce the burden of CVD risk factors in emerging adults have the promise of positively impacting CVD risk. Comprehensive approaches focused on population-level interventions and individual-level health behavior change, including addressing psychosocial stressors, are needed during the critical transitional period between adolescence and emerging adulthood. Strategic, tailored health promotion and disease prevention in emerging adulthood can prepare them for a healthier, more fulfilled middle age and beyond. A focus on the CVH of the youngest adults aligns with the AHA's commitment to health equity and CVH for all.

ARTICLE INFORMATION

The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.

This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on September 6, 2024, and the American Heart Association Executive Committee on September 23, 2024. A copy of the document is available at https:// profe ssional. heart. org/ state ments by using either "Search for Guidelines & Statements" or the "Browse by Topic" area.

The American Heart Association requests that this document be cited as follows: Scott J, Agarwala A, Baker-Smith CM, Feinstein MJ, Jakubowski K, Kaar J, Parekh This table represents the relationships of writing group members that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all members of the writing group are required to complete and submit. A relationship is considered to be "significant" if (a) the person receives $5000 or more during any 12-month period, or 5% or more of the person's gross income; or (b) the person owns 5% or more of the voting stock or share of the entity, or owns $5000 or more of the fair market value of the entity. A relationship is considered to be "modest" if it is less than "significant" under the preceding definition.

* Modest. † Significant. This table represents the relationships of reviewers that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all reviewers are required to complete and submit. A relationship is considered to be "significant" if (a) the person receives $5000 or more during any 12-month period, or 5% or more of the person's gross income; or (b) the person owns 5% or more of the voting stock or share of the entity, or owns $5000 or more of the fair market value of the entity. A relationship is considered to be "modest" if it is less than "significant" under the preceding definition.

|Term|Age range, y|Notes on the definition| |---|---|---|

|Adolescent|12-21|American Academy of Pediatrics|

|||definition, with ages 18-21 y|

|||defined as late adolescence 5|

|Emerging|18-25 (or 29)|Described by J. J. Arnett in 2000|

|adult||in response to shifting trends of|

|||when adolescents transition to|

|||independence. Also supported|

|||by neurobiological evidence|

|||showing the continued maturation|

|||in decision-making and brain|

|||development reaches adult levels|

|||closer to age 30 y 5,6|

|Young adult|18-44|The cutoff age of young adulthood|

|||varies widely. Age 44 y is often used|

|||but may extend up to age 55 y on|

|||the basis of commonly used cutoffs|

|||for premature CVD 7|

|Risk factor|Adolescents|Adult|Estimated prevalence| |---|---|---|---|

||follows the adult criteria||22.4% 45|

||||19.5% 46|

||Social and developmental|| |---|---|---|

|Lifestyle factor|factors|Examples of potential barrier|

|Diet|Life-stage considerations|Body dissatisfaction, unhealthy weight control behaviors, cooking skills, commercial marketing,|

|||peer influences, weight gain related to transition to independence/university, food-based coping|

||Social risk factors|Food insecurity, access to nutritious foods, financial resources available for food|

|Physical activity|Life-stage considerations|Decrease in active transportation such as walking or biking, decreased sports participation,|

|||increased sedentary behavior, parenting responsibilities|

||Social risk factors|Time constraints related to work, school, neighborhood crime|

|Tobacco use|Life-stage considerations|Experimentation, peer influence, electronic cigarettes, vaping, hookah, emotional health, and|

|||traumatic stress exposures|

||Social risk factor|Work or school schedule, noise|

|Disclosures||||||||| |---|---|---|---|---|---|---|---|---|

|Baker-Smith|Cardiovascular|funding) †|(Advisory|||||Children's|

||Research and||Board:|||||Health (director|

||Innovation,||Pediatric|||||of Pediatric|

||Nemours Cardiac||Renovascular|||||Preventive|

||Center, Nemours||Hypertension|||||Cardiology) †|

||Children's Health,||for PCORI)*||||||

||Sidney Kimmel||||||||

||Medical College of||||||||

||Thomas Jefferson||||||||

||University Cardiac||||||||

||Center||||||||

EN_PAPER

Cardiovascular Health in the Transition From Adolescence to Emerging Adulthood: A Scientific Statement From the American Heart Association

Abstract

Cardiovascular disease remains a leading cause of death in the United States, with an alarming rise in the proportion of young adults experiencing cardiovascular events. Many adolescents enter adulthood with significant cardiovascular disease risk factors. This scientific statement addresses the critical need for cardiovascular health promotion during emerging adulthood, a transitional stage between the ages of 18 and 25 or 29 years of age. We discuss the significance of social determinants of health and the interplay between individual-level risk factors and developmental changes, including shifts in substance use, social connections, and emotional well-being. We conclude by outlining strategies for optimizing cardiovascular health promotion and disease prevention, underscoring the importance of primordial prevention, early intervention, and tailored approaches to address the unique needs of emerging adults. Addressing these multifaceted factors is crucial for mitigating the burden of cardiovascular disease risk factors among emerging adults and promoting long-term cardiovascular well-being.

C

By identifying and addressing CVD risk factors early in the life span, primary prevention of CVD risk factor development has been associated with reduced CVD in mid and later adulthood. 34 However, screening best practices for these risk factors (Table 2 ) may differ according to pediatric versus adult guidelines, 43, 49 and some organizations, such as the US Preventive Services Task Force, find that there is insufficient evidence to support routine screening of asymptomatic individuals for hypertension and hyperlipidemia. 122, 123 nother challenge is the lack of representation of emerging adults in clinical trials focused on CVD prevention, an important priority for future research. 124, 125 f note, recent findings from behavioral clinical trials involving emerging and young adults are mixed but promising. A recent superiority trial in young adults Adapted with permission from Kris-Etherton et al. 105 © Copyright 2021 the American Heart Association, Inc.

(aged 18-39 years) found little support for aerobic exercise interventions improving blood pressure control 52 weeks after intervention, but there were cerebrovascular benefits. 126, 127 In the MyHEART (My Hypertension Education and Reaching Target) trial, telephone coaching plus ambulatory blood pressure monitoring was not superior to usual care, albeit both resulted in a 4.2-mm Hg reduction 6 months after intervention, 128 and the REACH (Richmond Emerging Adults Choose Health) trial, a behavioral weight loss program adapted for emerging adults (aged 18-25 years) produced a 3-kg weight loss at 6 months after intervention but no significant differences between groups with the motivational enhancements, 129 and other trials are underway. 130, 131 Also, lessons distilled from the 7 EARLY interventions, which consisted of 17 treatment arms using multiple approaches such as goals and planning, feedback and monitoring, and social support, but provided little information on which components may be the most important, are an essential step for further research on optimizing behavioral interventions and adaptive designs. 4, 132 ecruitment of emerging adults into clinical trials also merits consideration. Web-based recruitment via social media and private messaging through medical charts has successfully recruited this age group and is cost effective, but there has been limited success in using such approaches for retaining and engaging participants within the trials, another area of opportunity and innovation. 133

Risk Stratification for CVD During the Transitional Period

Because incidence rates for CVD events increase with each additional risk factor, 134 composite CVH scores are a better predictor of long-term CVD risk than an individual risk factor. 135 Current primary prevention guidelines recommend estimating the lifetime or 30-year risk for atherosclerotic CVD for young adults aged 20 to 39 years. 136 The pooled cohort risk equations, developed by the AHA and the American College of Cardiology, provide an age, sex, and racespecific estimation of lifetime atherosclerotic CVD risk for individuals aged ≥20 years. 137 The AHA Predicting Risk of CVD Events is a sex-specific, race-free, risk equation that provides 10-and 30-year estimates for CVD beginning at age 30 years. 138, 139 The predictive ability of this calculator is enhanced compared with other risk stratification tools by the addition of cardiovascular-kidney-metabolic factors (eg, urine albuminto-creatinine ratio), hemoglobin A 1c , and the zip code-level social deprivation index. 138, 139 In addition, there are many atherosclerotic CVD risk enhancers, including a family history of premature atherosclerotic CVD, persistently elevated low-density lipoprotein cholesterol ≥160 mg/dL, chronic kidney disease, metabolic syndrome, inflammatory diseases such as rheumatoid arthritis, and conditions such as preeclampsia and premature menopause, which should be considered when prescribing lipid-lowering therapy. 44 oung adults with low short-term risk but high longterm risk have not been thoroughly evaluated in lipid lowering trials, despite data suggesting this may be an important population to target with preventive therapies. 140 ansition From Pediatric to Adult Care

Early detection of risk factors and connecting youth with health care services is paramount. Among insured emerging adults, health care usage is < 40%, indicating that barriers to health care access are more complex than insurance status. 15 Innovative are needed, such as collaborations with community health centers, college health, employer-based programs, and creative use of technology, to reach emerging adults. A systematic review of barriers to health care access for adolescents and young adults identified a lack of knowledge of health care services, negative past experiences with care, and many organizationaland policy-level factors (eg, long wait times, poor care coordination); in contrast, youth-centered, web-based technologies and place-based care (college, employer) may help facilitate care. 141 he transition period represents a particularly vulnerable time for individuals with chronic disease and those at greatest risk for developing chronic disease. Best practices for transition from pediatric/adolescent practice to adult care recommend transition of care between the ages of 18 and 21 years. In a study of 60 233 adolescents, individuals were found to transition care later than recommended, and a gap of > 1 year was noted between pediatric and adult primary care. 142 The adjusted mean age at the time of transfer was 21.8 years for all office visits (eg, acute care, chronic disease management) and 23.1 years for preventive visits.

82 In another pilot randomized controlled trial, college smokers who were randomized to cognitive behavioral therapy (versus nutrition focused program) reduced smoking intensity by 50% and maintained reductions at 3 and 6 months after intervention, although there were no differences between intervention groups at follow-up time points. 83 Among a sample of 150 emerging adults with overweight or obesity and serious mental illness (eg, schizophrenia, bipolar disorder), 84 both group-based lifestyle intervention and mobile health coaching led to improvements in CVD outcomes over 12 months, including weight loss and improved cardiorespiratory fitness, although no differences emerged between groups. Finally, middle-aged adults with trauma histories who also reported stronger emotion regulation skills (reappraisal versus suppression) demonstrated lower systemic inflammation, indicating emotion regulation as a potential intervention target in emerging adulthood. 85, 86 Emotion regulation skills may help improve cardiovascular outcomes. Moreover, they may be feasible to deliver via mobile health interventions, which could be more scalable than in-person or group-based formats.

Social Media and Digital Health Literacy

Nearly all teens report using social media, and the frequency of use increases as they enter adulthood. 87 9] [90] There are opportunities to leverage an activity that is already part of daily routines as a tool for intervention delivery. A recent systematic review found that interactive social media interventions may significantly increase physical activity and fruit and vegetable intake, but study outcomes are mixed. 91 Social media interventions can face the same challenge as other interventions; participation and engagement with the content decrease significantly over time, and difficulties measuring engagement (eg, more passive engagement such as viewing content but not liking or leaving a comment). 92, 93 When social media was included as 1 component of multicomponent interventions, the acceptability of the social media component was sometimes lower than other components, such as text and email. 92 One explanation might be that behavioral change can be a sensitive topic for emerging adults, who are already intensely aware of peers' opinions, and participation in a behavioral change intervention may be socially undesirable. 94 The EARLY (Early Adult Reduction of Weight Through Lifestyle Intervention) consortium consisted of 7 weight-related clinical trials for young adults lasting 24 months each, with all interventions including a technology element such as texting, social media, and smartphone apps. 95 Despite the incorporation of technology and the wide use of social media among young adults, the results were variable, challenging the notion that technology alone is the ultimate solution for reaching young adults and effecting behavioral change. Another consideration is the rapid increase in social media platforms. Most published social media interventions use Facebook or an investigator-developed platform, but Facebook is used the least by emerging adults, with newer platforms being more popular (eg, TikTok, Instagram). 87 The rapidly growing technology and introduction of new platforms will challenge interventions seeking to use social media as a delivery strategy, but social media may be a channel for public health messaging given its widespread use and accessibility.

Nearly 100% of teens use the Internet daily, and 46% report almost constant use of the Internet, up from 24% in 2014. 87 Emerging adults, specifically Generation Z (born late 1990s-early 2000s), are more likely to seek health information online than other generations. 96 ealth professionals and educators alike are charged with beginning digital health literacy conversations with youth and emerging adults, such as evaluating website credibility and analyzing media messages and advertisements for mis-and disinformation. 97

Optimizing CVH Promotion and Disease Prevention

Parents significantly influence the dietary and physical activity behaviors of adolescents and emerging adults. Their modeling of weight maintenance behaviors and feeding practices (eg, pressure to eat, food restriction) is consistently associated with their child's risk of overweight, obesity, and unhealthy weight control behaviors as an adolescent and into adulthood. 110, 111 Practically, parents typically grocery shop and prepare meals, so efforts at increasing their "dietary literacy" could improve weight and other CVH metrics. For example, the Special Turku Coronary Risk Factor Intervention Project evaluated the longterm effects of diet counseling delivered to families and children beginning in infancy until age 20 years. 112 t the age of 26 years, the Special Turku Coronary Risk Factor Intervention Project led to superior cholesterol and glucose control. In addition to parental and family involvement, support from peers, colleagues, and significant others also influence diet and physical activity behaviors. 113 Finally, evidence suggests that fluctuations in physical activity influence weight maintenance; thus, it is critical to develop a better understanding of the specific factors influencing these fluctuations in emerging adulthood. 57 ealth-related technologies have also been proposed as a potentially useful method for improving access to health information, both to track lifestyle behaviors and motivations and to track weight, blood glucose, and blood pressure. 114 Applications such as MyFitnessPal, CalorieKing, Fitbit, MySugr, Glucose Buddy, and Lose It! ||Social risk factor|Health care access for cessation support, regional and geographic norms related to tobacco use|

|Sleep|Life-stage considerations|Change in chronobiology (later bedtimes), emotional health and traumatic stress exposures,|

|||parenting responsibilities|

|Writing Group Disclosures|||||||||

||||Other|Speakers'|||Consultant/||

|Writing group|||research|bureau/|Expert|Ownership|advisory||

||South Carolina|of Health (Mentored|||||||

|||researcher on an NIH|||||||

|||Diversity/Administrative|||||||

|||supplement|||||||

|||-R01NR020127-03S1) †|||||||

|Agarwala|and White Heart||||||||

||Hospital||||||||

|Feinstein|University|[eg, R01]) † ; AHA|||||Laboratories †||

||Medicine|(Strategically Focused|||||||

|||Research Network|||||||

|||Center and project|||||||

|||grants) †|||||||

|Jakubowski|Pittsburgh|Career Award|||||||

|||[K23HL159293]) † ;|||||||

|||NCATS|||||||

|||(UL1TR001857) †|||||||

||Colorado Anshutz||||||||

||Medical Campus||||||||

||University School||||||||

||of Global Public||||||||

||Health||||||||

|Patel|Methodist|R21HL169708|||||Nordisk*||

||DeBakey Heart|(research support|||||||

||and Vascular|from grant as|||||||

||Center|co-investigator) †|||||||

|Janna Stephens University of|None|None|None|None|None|None|None||

||Illinois Chicago,||||||||

||College of Nursing||||||||

References

引用 / 出处

2025 AHA科学声明：从青春期过渡到成年初期的心血管健康. 2025.