Early Cardiovascular Multimorbidity in Young Adults: Emerging Risk Profiles, Lifelong Exposure, and Strategies for Early Detection
DOI:
https://doi.org/10.64784/302Palabras clave:
cardiovascular multimorbidity, young adults, cardiovascular risk, cardiometabolic risk, early detection, obesity, hypertension, dyslipidemia, lipoprotein(a), apolipoprotein B, lifetime risk, cardiovascular preventionResumen
Cardiovascular multimorbidity in young adults is an increasingly relevant clinical and public health concern because multiple cardiovascular, metabolic, renal, behavioral, and psychosocial risk factors may coexist long before overt cardiovascular disease becomes clinically evident. This study analyzed the emerging burden of cardiovascular multimorbidity in young adults, emphasizing conventional and emerging risk factors, early detection strategies, and population-level consequences. An integrative literature review was conducted using recent epidemiological studies, prospective cohorts, systematic reviews, scientific statements, and contemporary cardiovascular risk frameworks. The evidence showed that obesity, dyslipidemia, hypertension, impaired glucose metabolism, nicotine exposure, physical inactivity, poor sleep, and psychosocial factors frequently cluster during early adulthood. Additional markers such as apolipoprotein B, lipoprotein(a), renal dysfunction, central adiposity, and cumulative low-density lipoprotein cholesterol exposure may provide complementary information regarding long-term cardiovascular vulnerability. The findings also demonstrated that short-term cardiovascular risk estimates may underestimate the lifetime impact of prolonged exposure to multiple risk factors in younger individuals. Early detection therefore requires a multidimensional approach integrating clinical, anthropometric, laboratory, behavioral, familial, and social information. From a population perspective, the early onset of multimorbidity may increase future cardiovascular events, chronic healthcare utilization, premature disability, and economic burden. A life-course approach to cardiovascular prevention, focused on early recognition and reduction of cumulative risk exposure, may improve long-term cardiovascular health and limit progression toward established cardiovascular disease.
Referencias
• Ahmed, H. M., Rehman, U. U., Owais, M., & Saeed, M. Y. (2026). The accelerating crisis of metabolic multimorbidity in young U.S. adults: A 26-year analysis of national trends, disparities, and projections to 2031. Nutrition, Metabolism and Cardiovascular Diseases, Article 104858. https://doi.org/10.1016/j.numecd.2026.104858
• Agudelo-Botero, M., Dávila-Cervantes, C. A., & Giraldo-Rodríguez, L. (2024). Cardiometabolic multimorbidity in Mexican adults: A cross-sectional analysis of a national survey. Frontiers in Medicine, 11, 1380715. https://doi.org/10.3389/fmed.2024.1380715
• Aggarwal, R., Ostrominski, J. W., & Vaduganathan, M. (2024). Prevalence of cardiovascular-kidney-metabolic syndrome stages in US adults, 2011–2020. JAMA, 331(21), 1858–1860. https://doi.org/10.1001/jama.2024.6892
• Ndumele, C. E., Rangaswami, J., Chow, S. L., Neeland, I. J., Tuttle, K. R., Khan, S. S., Coresh, J., Mathew, R. O., Baker-Smith, C. M., Carnethon, M. R., Després, J.-P., Ho, J. E., Joseph, J. J., Kernan, W. N., Khera, A., Kosiborod, M. N., Lekavich, C. L., Lewis, E. F., Lo, K. B., . . . Elkind, M. S. V. (2023). Cardiovascular-kidney-metabolic health: A presidential advisory from the American Heart Association. Circulation, 148(20), 1606–1635. https://doi.org/10.1161/CIR.0000000000001184
• Khan, S. S., Matsushita, K., Sang, Y., Ballew, S. H., Grams, M. E., Surapaneni, A., Blaha, M. J., Carson, A. P., Chang, A. R., Ciemins, E., Go, A. S., Gutierrez, O. M., Hwang, S.-J., Jassal, S. K., Kovesdy, C. P., Lloyd-Jones, D. M., Shlipak, M. G., Palaniappan, L. P., Sperling, L., . . . Coresh, J. (2024). Development and validation of the American Heart Association’s PREVENT equations. Circulation, 149(6), 430–449. https://doi.org/10.1161/CIRCULATIONAHA.123.067626
• Lloyd-Jones, D. M., Allen, N. B., Anderson, C. A. M., Black, T., Brewer, L. C., Foraker, R. E., Grandner, M. A., Lavretsky, H., Perak, A. M., Sharma, G., & Rosamond, W. (2022). Life’s Essential 8: Updating and enhancing the American Heart Association’s construct of cardiovascular health: A presidential advisory from the American Heart Association. Circulation, 146(5), e18–e43. https://doi.org/10.1161/CIR.0000000000001078
• Lloyd-Jones, D. M., Ning, H., Labarthe, D., Brewer, L., Sharma, G., Rosamond, W., Foraker, R. E., Black, T., Grandner, M. A., Allen, N. B., Anderson, C., Lavretsky, H., & Perak, A. M. (2022). Status of cardiovascular health in US adults and children using the American Heart Association’s new “Life’s Essential 8” metrics: Prevalence estimates from the National Health and Nutrition Examination Survey (NHANES), 2013 through 2018. Circulation, 146(11), 822–835. https://doi.org/10.1161/CIRCULATIONAHA.122.060911
• Jacobs, D. R., Jr., Woo, J. G., Sinaiko, A. R., Daniels, S. R., Ikonen, J., Juonala, M., Kartiosuo, N., Lehtimäki, T., Magnussen, C. G., Viikari, J. S. A., Zhang, N., Bazzano, L. A., Burns, T. L., Prineas, R. J., Steinberger, J., Urbina, E. M., Venn, A. J., Raitakari, O. T., & Dwyer, T. (2022). Childhood cardiovascular risk factors and adult cardiovascular events. The New England Journal of Medicine, 386(20), 1877–1888. https://doi.org/10.1056/NEJMoa2109191
• Zhang, Y., Pletcher, M. J., Vittinghoff, E., Clemons, A. M., Jacobs, D. R., Jr., Allen, N. B., Alonso, A., Bellows, B. K., Oelsner, E. C., Zeki Al Hazzouri, A., Kazi, D. S., de Ferranti, S. D., & Moran, A. E. (2021). Association between cumulative low-density lipoprotein cholesterol exposure during young adulthood and middle age and risk of cardiovascular events. JAMA Cardiology, 6(12), 1406–1413. https://doi.org/10.1001/jamacardio.2021.3508
• Kronenberg, F., Mora, S., Stroes, E. S. G., Ference, B. A., Arsenault, B. J., Berglund, L., Dweck, M. R., Koschinsky, M., Lambert, G., Mach, F., McNeal, C. J., Moriarty, P. M., Natarajan, P., Nordestgaard, B. G., Parhofer, K. G., Virani, S. S., von Eckardstein, A., Watts, G. F., Stock, J. K., . . . Catapano, A. L. (2022). Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: A European Atherosclerosis Society consensus statement. European Heart Journal, 43(39), 3925–3946. https://doi.org/10.1093/eurheartj/ehac361
• Rose, J. J., Krishnan-Sarin, S., Exil, V. J., Hamburg, N. M., Fetterman, J. L., Ichinose, F., Perez-Pinzon, M. A., Rezk-Hanna, M., & Williamson, E. (2023). Cardiopulmonary impact of electronic cigarettes and vaping products: A scientific statement from the American Heart Association. Circulation, 148(8), 703–728. https://doi.org/10.1161/CIR.0000000000001160
• Meher, M., Pradhan, S., & Pradhan, S. R. (2023). Risk factors associated with hypertension in young adults: A systematic review. Cureus, 15(4), e37467. https://doi.org/10.7759/cureus.37467
• Kim, C.-Y., Lee, C. M., Lee, S., Yoo, J. E., Lee, H., Park, H. E., Han, K., & Choi, S.-Y. (2023). The association of smoking status and clustering of obesity and depression on the risk of early-onset cardiovascular disease in young adults: A nationwide cohort study. Korean Circulation Journal, 53(1), 17–30. https://doi.org/10.4070/kcj.2022.0179
• Tang, R., An, J., Bellows, B. K., Moran, A. E., & Zhang, Y. (2025). Trends in hypertension prevalence, awareness, treatment, and control among US young adults, 2003–2023. American Journal of Hypertension, 38(8), 551–559. https://doi.org/10.1093/ajh/hpaf044
• Nagata, J. M., Vittinghoff, E., Dooley, E. E., Lin, F., Rana, J. S., Sidney, S., & Gabriel, K. P. (2024). TV viewing from young adulthood to middle age and cardiovascular disease risk. American Journal of Preventive Medicine, 66(3), 427–434. https://doi.org/10.1016/j.amepre.2023.11.004
• Miley, K. M., Hooker, S. A., Crain, A. L., O’Connor, P. J., Haapala, J. L., Bond, D. J., & Rossom, R. C. (2023). 30-year cardiovascular disease risk for young adults with serious mental illness. General Hospital Psychiatry, 85, 139–147. https://doi.org/10.1016/j.genhosppsych.2023.10.015
• Rajagopalan, S., Brauer, M., Bhatnagar, A., Bhatt, D. L., Brook, J. R., Huang, W., Münzel, T., Newby, D., Siegel, J., & Brook, R. D. (2020). Personal-level protective actions against particulate matter air pollution exposure: A scientific statement from the American Heart Association. Circulation, 142(23), e411–e431. https://doi.org/10.1161/CIR.0000000000000931
• Agarwala, A., Patel, J., Stephens, J., Roberson, S., Scott, J., Beckie, T., & Jackson, E. A. (2023). Implementation of prevention science to eliminate health care inequities in achieving cardiovascular health: A scientific statement from the American Heart Association. Circulation, 148(15), 1183–1193. https://doi.org/10.1161/CIR.0000000000001171
• Masrouri, S., Tamehri Zadeh, S. S., Afaghi, S., Hadaegh, F., Khalili, D., & Shapiro, M. D. (2024). Association of anthropometric indices with midlife cardiovascular risk in young individuals without obesity and traditional risk factors. Journal of the American Heart Association, 13(13), e033355. https://doi.org/10.1161/JAHA.123.033355
• Zou, X., Zhao, J., Feng, A., Chan, K. H. K., Wu, W.-C., Manson, J. E., Liu, S., & Li, J. (2024). Adversities in childhood and young adulthood and incident cardiovascular diseases: A prospective cohort study. eClinicalMedicine, 69, 102458. https://doi.org/10.1016/j.eclinm.2024.102458
