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Background  Middle‐aged adults with ideal blood pressure, cholesterol, and glucose levels exhibit substantially lower cardiovascular mortality than those with unfavorable levels. Four healthy lifestyle components—optimal body weight, diet, physical activity, and not smoking—are recommended for cardiovascular health ( CVH ). This study quantified associations between combinations of healthy lifestyle components measured in young adulthood and loss of the ideal  CVH  profile into middle age.    Methods and Results  Analyses included 2164 young adults in the Coronary Artery Risk Development in Young Adults study with the ideal  CVH  profile (defined as untreated blood pressure <120/80 mm Hg, total cholesterol <200 mg/ dL , fasting blood glucose <100 mg/ dL , and absence of cardiovascular disease) at baseline. Cox proportional hazards regression models estimated hazard ratios for loss of the ideal  CVH  profile over 25 years according to 4 individual and 16 combinations of optimal healthy lifestyle components measured in young adulthood: body mass index, physical activity, nonsmoking status, and diet quality. Models were adjusted for age, sex, race, education, study center, and baseline blood pressure, cholesterol, and glucose. Eighty percent (n=1737) of participants lost the ideal  CVH  profile by middle age; loss was greatest for young adults with no optimal healthy lifestyle components at baseline. Relative to young adults with no optimal healthy lifestyle components, those with all 4 were less likely to lose the ideal  CVH  profile (hazard ratio 0.59, 95%  CI  0.44–0.80). Combinations that included optimal body mass index and nonsmoking status were each associated with lower risk.    Conclusions  Optimal body mass index and not smoking in young adulthood were protective against loss of the ideal  CVH  profile through middle age. Importance of diet and physical activity may be included through their effects on healthy weight.

Optimal Lifestyle Components in Young Adulthood Are Associated With Maintaining the Ideal Cardiovascular Health Profile Into Middle Age