Emerging adulthood – around 18-25 – is full of major transitions, but also a stage where behaviours that diminish heart health become more common. In fact, only about one in four youths maintain positive health behaviour patterns during the transition to adulthood, writes Jewel Scott in The Conversation.
She writes:
More Americans die of heart disease than of any other condition, and while people often think of this as an illness affecting mostly older people, data show that the rate of heart disease in under-40s has more than doubled since 2010 and tripled among people who use tobacco.
Researchers like me are learning a great deal more about how heart health later in life heavily depends on the habits built during late adolescence and early adulthood.
I am a primary care nurse practitioner and researcher studying how early life shapes long-term heart health. In my clinical practice, I frequently care for people in their early 20s who are entering adulthood but are already facing serious cardiovascular risk factors, like elevated blood pressure, high blood sugar or a BMI in the obesity range.
Just as young people on the cusp of adulthood make important decisions about their education, career and relationships, the health habits they build during this critical time also lay the foundation for lifelong heart health and better quality of life.
Early roots of heart disease
The most common form of heart disease is atherosclerotic cardiovascular disease, when sticky, fatty plaque builds up in the blood vessels and makes it harder for blood to flow.
Heart health doesn’t suddenly decline in middle age. It starts to slip much earlier, often without people realising it. Research shows that a key turning point is actually around the age of 17. That’s when overall heart health scores based on behaviours like diet, movement and sleep, along with clinical measures such as blood pressure, begin to worsen.
That means by the time many young people are finishing high school, heart disease risk factors are already emerging. The good news is that most of the risk factors that drive this build-up are modifiable.
In a report I co-authored in March 2025, my colleagues and I explored the key risk factors for heart disease in emerging adults.
One of the most important is nicotine exposure. Use of cigarettes, vapes and other nicotine products has surged among young adults in recent years, from 21% of 18- to 23-year-olds in 2002 to 43% in 2018.
Nicotine damages blood vessels and speeds up the plaque formation process, increasing the risk of serious heart problems later in life. While signs such as chest discomfort or shortness of breath tend to show up much later, the groundwork for those symptoms is laid much earlier.
Obesity is another early risk factor. In fact, one in five under-25s have a BMI of 30 or higher, and projections suggest nearly three in five will meet that threshold by 35.
Meanwhile, fewer than half of adults aged 18-34 recognise high cholesterol, obesity, high blood pressure and lack of physical activity as heart disease risk factors. These early warning signs, often uncovered during routine check-ups, can set the stage for future heart disease.
Societal factors shape heart health, too
Beyond healthcare access, the conditions of people’s daily lives, such as where they live, their education level and their economic stability, also play important roles in heart health.
Education and stable employment are tied to healthcare access, lower stress and food security, all of which support a healthier heart.
Healthy social connections matter, too. Strong, supportive relationships are linked to better overall well-being, including heart health.
Recently, several major health organisations have spotlighted loneliness as a public health issue. However, there is still a lot to learn about exactly how social connections translate to healthier lives, and not enough of this research focuses on young adults.
Research shows that one in three teens report near-constant use of social media, but those connections do not yield the same health benefits as interacting in real life. In my own research, I am investigating how social connection affects heart health in young adults in particular.
Building a foundation for heart health
There is a lot that can be done early to make a difference in heart health. In our recent report, written with the American Heart Association, my colleagues and I highlighted a group of eight risk factors that people can modify to reduce their heart disease risk, called the Essential 8.
Four are health behaviours. Apart from avoiding nicotine, young people should get 150 minutes of moderate to vigorous activity a week, or around 20 minutes daily, and also get seven to nine hours of sleep nightly. Eating a diet rich in fish, berries and vegetables is also recommended.
Of these four behaviours, US children score worst on diet – an important area for improvement in the transition to adulthood. Young adults with stronger cooking skills tend to have healthier eating habits in middle age.
The other four factors are clinical measures: blood pressure, blood sugar, cholesterol and BMI. Since the early 2000s, three of the four – blood pressure, blood sugar and BMI – have all worsened among young adults.
Jewel Scott – Assistant Professor of Nursing Science, University of South Carolina
See more from MedicalBrief archives:
High blood sugar tied to heart damage in youngsters – Finnish study
Vaping scourge among children prompts long-term health effects study
Childhood signs that predict stroke/heart attacks in adulthood – large global study