Study finds most young adults in Puerto Rico may have less-than-ideal heart health

Many young adults in Puerto Rico may have less-than-ideal cardiovascular health due to lifestyle behaviors that could increase their risk of heart disease and stroke later in life, new research suggests.

The study found that nearly three out of four Puerto Rican adults ages 18 to 29 had suboptimal cardiovascular health scores because of low scores for healthy eating, physical activity and body mass index.

It is the first to focus on the cardiovascular health of adults in the U.S. territory using risk metrics known as Life’s Essential 8. The findings were published in the Journal of the American Heart Association.

“Young adulthood is a very important phase in terms of when young adults establish their lifelong lifestyle habits,” said the study’s co-lead author Dr. Milagros Rosal, vice provost for health equity at the University of Massachusetts Chan Medical School in Worcester. She is also a professor in the department of population and quantitative health sciences and medicine at UMass Chan.

“Being able to understand how stable this cardiovascular risk or cardiovascular health score is, the factors that contribute to the deterioration and what things could potentially improve cardiovascular health” are critical questions for this population.

Among Hispanic adults in the U.S. who are 20 and older, 52% of men and 37% of women have cardiovascular disease, according to American Heart Association statistics.

Previous research has shown subpar cardiovascular health among U.S. adults ages 18 to 44 and young Puerto Rican adults in the continental U.S., and a previous but smaller study found the same for Puerto Rican adults ages 18 to 23 living in the island’s main metropolitan areas of San Juan and Caguas.

“The studies that have been conducted in the U.S. indicate that cardiovascular health is suboptimal among young adults, so we wanted to check whether the same pattern applied to Puerto Ricans on the island,” said co-lead author Dr. Cynthia M. Pérez, a professor in the department of biostatistics and epidemiology at the University of Puerto Rico Graduate School of Public Health in San Juan.

Filling this knowledge gap is essential, according to the study’s authors, because of the high prevalence of obesity, physical inactivity and smoking among young adults in Puerto Rico—lifestyle factors that increase their risk of cardiovascular disease.

Researchers examined data collected from 2020 to 2023 for 2,162 participants in PR-OUTLOOK, an ongoing study of the relationship between stress and cardiovascular risk factors among adults 18 to 29 in Puerto Rico. Each participant was scored using Life’s Essential 8, a set of lifestyle behaviors and health factors identified by the AHA to improve and maintain good cardiovascular health.

It is composed of diet quality, physical activity, nicotine exposure (including vaping), sleep duration, BMI (a ratio of weight to height), and levels of non-HDL (“bad”) cholesterol, blood pressure and blood glucose. Overall scores were then categorized as ideal, intermediate or poor.

About 27% of the participants had an ideal overall score, 69% were intermediate, and nearly 4% were poor. Although a majority of participants had high ideal scores for blood glucose level, nicotine exposure, sleep duration, non-HDL cholesterol and blood pressure, they had poor scores for diet quality, physical activity and BMI.

“We also determined significant sex differences in overall cardiovascular health and in four of the eight cardiovascular health components,” Pérez said. Nearly 30% of women had an overall ideal cardiovascular health score compared to 24% of men. “Men had lower nicotine exposure, lower non-HDL cholesterol and higher blood pressure, whereas women had lower physical activity scores,” she said.

Dr. Olveen Carrasquillo, a professor of medicine and public health sciences at the University of Miami’s Miller School of Medicine, said he was glad the researchers are collecting data on cardiovascular health in Puerto Rico, which he said is often overlooked in national health surveys.

The findings show that “you do have a lot of (young) people in that gray zone where you want to intervene now so that when they’re 40, they don’t start coming down with heart disease and other problems,” said Carrasquillo, who was born in Puerto Rico and grew up in New York. He was not involved in the research.

The “most striking” result, he said, was the low scores for physical activity. “It’s a wake-up call for everyone to be more active.”

Many young people in Puerto Rico face systemic barriers to achieving the best health, including food insecurity, poverty, a shortage of health care professionals, and an ongoing financial crisis on the island, the study’s authors noted. Puerto Rico’s debt repayment obligations appropriate money that could be better spent on health care, Carrasquillo said.

“I think a much better investment of the island’s dollars is not in paying off their debt,” he said. “It’s in investing in the young people so that they can be healthy and productive.”

The findings also drive home that cardiovascular health can begin to decline as early as adolescence, Pérez said. At that stage of life, young people can take steps to reduce their risk of cardiovascular disease by adopting healthier lifestyle habits, such as eating a balanced diet, exercising regularly, not smoking or vaping, maintaining a healthy weight and getting quality sleep.

“Cardiovascular health in young adulthood is strongly associated with premature cardiovascular disease and all-cause mortality,” Pérez said, “so I think it’s important for everyone, not only young adults, to become aware of how to promote cardiovascular health.”