Researchers analyzed data from 1,030,504 US adults between 18 and 44 years old who participated in the Behavioral Risk Factor Surveillance System, or BRFSS, between 2015 and 2024. The BRFSS is a large, ongoing national health survey coordinated by the US Centers for Disease Control and Prevention. It collects information on health conditions, health behaviors, access to medical care, insurance status, and socioeconomic circumstances. In this study, the investigators used the survey to estimate the prevalence of early-onset cardiovascular disease and to examine how social conditions intersected to create distinct patterns of risk across the young adult population.

Across the entire sample, the weighted prevalence of early-onset cardiovascular disease was 2.1 percent. On the surface, that figure may appear modest, but its national implications are substantial because it applies to a very large population. More importantly, the average concealed enormous differences between social groups. The researchers divided participants into 240 intersectional strata based on combinations of sex, race or ethnicity, education, income, and health insurance coverage. The estimated probability of cardiovascular disease ranged from just 0.04 percent in the lowest-risk stratum to 15.91 percent in the highest-risk stratum, representing a more than 400-fold difference.

To investigate these patterns, the team used a statistical framework known as Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy, or MAIHDA. Unlike conventional analyses that examine sex, race, income, or education one variable at a time, MAIHDA treats each combination of characteristics as a social context. This allows researchers to distinguish between two effects. The first is the additive effect, in which each disadvantage contributes independently to risk. The second is the intersectional effect, in which the combination produces an outcome that is greater or smaller than the sum of its separate parts. In practical terms, the method asks whether belonging simultaneously to several socially disadvantaged groups creates a unique pattern of risk.

The statistical results indicated substantial heterogeneity between the 240 strata. The variance partition coefficient, or VPC, was 23.5 percent, meaning that nearly one-quarter of the unexplained variation in cardiovascular disease prevalence was associated with differences between the intersectional groups rather than only with individual-level variation. The median odds ratio, or MOR, was 2.60. This measure translates group-level variation into an odds-ratio scale: if two otherwise similar individuals were randomly selected from two different strata, the median difference in their odds of cardiovascular disease would be 2.6-fold. Together, the VPC and MOR indicate that social patterning was not a minor statistical detail but a substantial feature of the data.

The analysis also showed that standard additive models captured only 44.6 percent of the observed inequality. In other words, simply assigning separate effects to sex, race or ethnicity, education, income, and insurance would leave more than half of the disparity unexplained. Of the 235 strata with sufficient information for detailed intersectional assessment, 99—42.1 percent—showed statistically significant intersectional effects. Fifty-eight strata experienced what the researchers described as intersectional penalties, with cardiovascular risk higher than expected from the individual characteristics alone. Forty-one showed intersectional protections, with risk lower than expected.

One of the most unexpected patterns involved Asian adults, who appeared prominently at both extremes of the risk distribution. The highest predicted risk was observed among uninsured, low-income, low-education Asian men, whose estimated probability of early-onset cardiovascular disease reached 15.91 percent. At the same time, other Asian strata were among the groups with the lowest predicted risk. This divergence illustrates why broad racial categories can conceal major internal differences. A population that appears relatively protected when considered as a whole may contain smaller groups facing severe risks because of interactions involving economic hardship, limited education, lack of insurance, gender, migration-related barriers, occupational conditions, or restricted access to preventive care.

The researchers then compared the period before the COVID-19 pandemic with the years following its onset to determine whether these disparities changed over time. The median odds ratio increased from 3.43 before the pandemic to 4.19 afterward, corresponding to a relative increase of 22.2 percent. This pattern suggests that the distance between high-risk and low-risk intersectional groups widened after the pandemic. However, the confidence interval for the relative change ranged from a slight decrease of 0.4 percent to an increase of 44.7 percent, indicating statistical uncertainty around the exact size of the change. The result should therefore be interpreted as evidence of a concerning widening trend rather than definitive proof that the pandemic alone caused the increase.

The findings point toward mechanisms that operate across multiple levels of society. Uninsurance can delay diagnosis and limit access to blood-pressure checks, cholesterol testing, diabetes screening, and treatment. Low income can increase exposure to unstable housing, food insecurity, chronic stress, and jobs with irregular schedules or physical hazards. Lower educational opportunity may affect health literacy and the ability to navigate a fragmented healthcare system, although education itself is also closely tied to employment and income. These conditions can influence smoking, diet, physical activity, sleep, medication access, and exposure to chronic stress. Over time, such pressures may contribute to hypertension, metabolic disease, inflammation, and vascular injury—the biological pathways that accelerate cardiovascular disease at younger ages.

Because the study used retrospective serial cross-sectional data, it can identify population patterns but cannot establish that any particular social characteristic directly caused cardiovascular disease in an individual. The BRFSS also relies heavily on survey responses, and the analysis may not capture every relevant factor, including neighborhood conditions, immigration status, occupational exposures, detailed healthcare use, or the quality of insurance coverage. Even so, the scale of the dataset and the use of an intersectional statistical model provide a powerful warning: treating young adults as a single low-risk population may hide concentrated pockets of severe disease. The authors argue that prevention should move beyond individual lifestyle advice toward structurally informed strategies, including affordable coverage, earlier screening, culturally responsive care, and targeted support for multiply marginalized communities. As early-onset cardiovascular disease becomes more visible, the study suggests that the most effective interventions will need to address not only what individuals do, but also the social environments that determine which healthy choices are realistically available.

Subject of Research: Early-onset cardiovascular disease and intersectional health inequalities among US adults aged 18–44

Article Title: Early-onset CVD at the intersection of sex, race/ethnicity, education, income, and health insurance in the US: a nationwide intersectional analysis

Article References: Gu, J., Li, J., Wu, S. et al. “Early-onset CVD at the intersection of sex, race/ethnicity, education, income, and health insurance in the US: a nationwide intersectional analysis.” BMC Public Health (2026).

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29108-z

Keywords: Cardiovascular disease, early-onset CVD, intersectionality, health inequities, social determinants of health, young adults, COVID-19 pandemic, BRFSS, MAIHDA, health insurance

The investigation draws its data from two pivotal and long-standing cohort studies: the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study and the Multi-Ethnic Study of Atherosclerosis (MESA). MASALA provides a focused lens on South Asian participants, whose ancestry traces back to Bangladesh, India, Nepal, Pakistan, or Sri Lanka, while MESA offers a comprehensive view of other major ethnic groups. The temporal alignment of follow-up exams between 2016 and 2018 ensures robust comparability between datasets despite the decade gap in baseline data collection.

Key cardiovascular risk factors assessed include hypertension, dyslipidemia, prediabetes, and type 2 diabetes. Remarkably, South Asian men at 45 years exhibited a prediabetes prevalence approximately eight times higher than their White counterparts (30.7% vs. 3.9%), a disparity that signals profound metabolic alterations preceding overt cardiovascular disease. Additionally, blood pressure evaluations demonstrated elevated hypertension rates in South Asian men—25.5% versus 18.4% in White men and markedly lower percentages in Chinese and Hispanic cohorts—indicating early vascular dysfunction.

Further compounding these risks was the high prevalence of dyslipidemia among South Asian men, with nearly four-fifths exhibiting elevated cholesterol or triglycerides compared to around 60% in Black men, underscoring pronounced lipid metabolism disturbances. South Asian women, while showing somewhat lower absolute prevalence, still bore nearly double the burden of prediabetes at 17.6% compared to White women at 5.7%, highlighting sex-specific vulnerability within this population and the necessity for targeted preventive strategies.

Intriguingly, the study found that these heightened risk factor prevalences occur despite South Asians demonstrating superior dietary quality, reduced alcohol consumption, and comparable physical activity levels relative to other ethnic groups. This dichotomy implicates intrinsic pathophysiological or genetic predispositions alongside environmental factors, suggesting that conventional lifestyle recommendations may require recalibration for this demographic.

The methodology incorporated self-reported lifestyle behaviors analyzed through the framework of the American Heart Association’s Life’s Essential 8, thereby integrating diet quality, physical activity, and alcohol usage into the broader cardiovascular risk assessment. While self-reporting inherently introduces potential recall bias, its consistency across cohorts facilitates meaningful comparative insights.

This pioneering work carries significant clinical implications, particularly the call by senior author Dr. Namratha Kandula for earlier and tailored screening regimens in South Asian adults. Emphasizing proactive surveillance of blood pressure, glycemic indices (glucose and HbA1c), and lipid profiles from early adulthood could enable timely intervention, potentially attenuating the trajectory toward overt atherosclerotic cardiovascular disease (ASCVD).

Supporting these findings, a 2023 scientific statement from the American Heart Association corroborated the disproportionate ASCVD risk among South Asians, attributing it to accelerated arterial plaque accumulation. It advocates nuanced dietary modifications emphasizing whole grains, caregiving in oil choice towards unsaturated fats, and eschewing deep-fried foods to mitigate these risks effectively.

This study’s longitudinal design articulates a compelling narrative of premature cardiovascular risk emergence in South Asians, accentuating the imperative for ethnicity-specific research and healthcare frameworks. The early manifestation of hypertension, dyslipidemia, and glucose metabolism disturbance necessitates a paradigm shift in clinical risk stratification beyond the traditional one-size-fits-all approach.

Nonetheless, limitations exist. The reliance on self-reported behavioral data may under- or overestimate true lifestyle exposures. Moreover, participant retention skewed towards higher socioeconomic and educational strata may constrain generalizability across the broader South Asian diaspora. The decade gap between initial MASALA and MESA baseline examinations further complicates direct temporal comparisons, yet the findings remain robust and clinically relevant.

Future research avenues beckon deeper exploration of genetic, epigenetic, and environmental interactions fueling this early cardiometabolic vulnerability in South Asians. Identification of biomarkers predictive of accelerated risk could herald precision medicine strategies, while culturally tailored public health campaigns may optimize preventive engagement within these communities.

In conclusion, this study illuminates a pressing public health concern: South Asian adults in the U.S. harbor elevated cardiovascular risk factors much earlier than their ethnic peers, necessitating urgent, customized clinical attention. Integrating these insights into clinical practice and policymaking can redefine preventive cardiology, ultimately reducing the burden of heart disease and stroke in this fast-growing and historically underserved population.

Subject of Research: Cardiovascular risk factors prevalence and trends among middle-aged South Asian adults compared with other racial and ethnic groups in the United States.

Article Title: Prevalence and Trends in Cardiovascular Risk Factors Among Middle-Aged South Asian Adults Compared With Other Racial and Ethnic Groups in the United States: A Longitudinal Analysis of 2 Cohort Studies

News Publication Date: February 11, 2026

Web References:

• Journal of the American Heart Association: http://dx.doi.org/10.1161/JAHA.124.041221
• American Heart Association Life’s Essential 8: https://www.heart.org/en/healthy-living/healthy-lifestyle/lifes-essential-8
• AHA Scientific Statement on South Asians and ASCVD: https://www.ahajournals.org/doi/epdf/10.1161/CIR.0000000000001145

Keywords: Cardiovascular disorders, Heart disease, Coronary artery disease, Blood pressure, Diabetes

The importance of the Lp(a) AW(a)RE initiative is underscored by the involvement and financial sponsorship of Eli Lilly and Company, marking a significant collaboration between nonprofit advocacy and the pharmaceutical industry. The program is designed explicitly for primary care clinicians, healthcare insurers, and policymakers across the United States. It encompasses a series of educational symposia embedded within leading medical conferences nationwide, providing a platform for knowledge exchange and raising awareness about Lp(a) among healthcare professionals. These conferences offer free Lp(a) screenings alongside comprehensive educational materials, underscoring the program’s commitment to tangible, actionable interventions.

Katherine Wilemon, the founder and CEO of the Family Heart Foundation, stressed the critical role of this program in tackling the pervasive burden of cardiovascular disease in the U.S., where it accounts for one in every three deaths. She articulated a strong vision for the initiative focusing on the prevention of premature cardiovascular events by accelerating the identification and management of genetic risk factors such as elevated Lp(a). By combining patient narratives, expert medical presentations, and direct screenings, Lp(a) AW(a)RE aims to revolutionize clinical understanding and eventually reduce the prevalence of undiagnosed cases within high-risk populations.

Elevated lipoprotein(a) represents a triple threat in cardiovascular pathology due to its potential to promote thrombosis, atherogenesis, and arterial inflammation. These three interconnected biological processes collectively accelerate the onset and progression of ASCVD, often manifesting aggressively in younger individuals. The clinical challenge lies in the fact that those with high Lp(a) levels frequently fail to meet low-density lipoprotein cholesterol (LDL-C) treatment targets, leaving them vulnerable to recurrent primary and secondary cardiovascular events. This observation highlights a significant unmet need for early diagnosis and personalized LDL-C management strategies in these patients.

From a biochemical standpoint, Lp(a) is an LDL-like particle with an apolipoprotein(a) molecule covalently bound to apolipoprotein B-100. This unique structure contributes to its atherogenic and thrombogenic properties, distinct from other lipoproteins. The pro-inflammatory and prothrombotic effects of Lp(a) arise from its ability to infiltrate arterial walls, promoting foam cell formation, endothelial dysfunction, and platelet aggregation. These pathological changes underscore why elevated levels predispose individuals to premature coronary artery disease, ischemic stroke, and peripheral arterial disease, reinforcing the need for targeted detection and intervention.

Despite the clear clinical implications, Lp(a) is not routinely measured in standard lipid panels, leading to under-recognition among healthcare providers. Current clinical guidelines often do not universally recommend Lp(a) screening, partly due to a historical lack of consensus and payer reimbursement issues. Compounding this problem is the insufficient understanding among clinicians regarding the interpretation of Lp(a) levels and their integration into cardiovascular risk assessment models. However, emerging evidence indicates that aggressive management of traditional cardiovascular risk factors—such as hypertension, hypercholesterolemia, and smoking cessation—can attenuate the risk associated with elevated Lp(a), making early identification all the more crucial.

The Family Heart Foundation’s initiative also aims to address systemic barriers within health insurance frameworks. Many payers do not currently authorize coverage for Lp(a) testing, deeming it experimental or non-essential. This has resulted in significant access disparities, particularly disadvantaging populations at high genetic risk. By engaging policymakers and insurance providers, the Lp(a) AW(a)RE initiative seeks to push for comprehensive coverage policies that facilitate widespread Lp(a) screening and integrate it into routine cardiovascular risk stratification.

Looking ahead, the Family Heart Foundation plans to expand its awareness efforts with an “Lp(a) Awareness to Action” campaign slated for early 2026. This upcoming phase will include the launch of a dedicated consumer-facing website alongside a free, at-home Lp(a) testing program. These innovative features will be supplemented by personalized support services through the Foundation’s Care Navigation Center, designed to guide individuals through risk interpretation, lifestyle modifications, and treatment pathways. This approach aligns with a patient-centric model of care, empowering individuals with actionable knowledge and resources.

The efforts of the Family Heart Foundation are built upon a robust legacy of advancing research and advocacy related to familial hypercholesterolemia (FH) and Lp(a). Since its establishment in 2011 as the FH Foundation, the organization has employed real-world evidence and patient-driven strategies to dismantle barriers in the diagnosis and management of inherited lipid disorders. It functions as an intersectional hub involving patients, clinicians, researchers, and policymakers to foster education, drive legislative change, and propel innovative research forward.

The clinical community recognizes that genetic dyslipidemias, including elevated Lp(a), transcend traditional cardiovascular risk paradigms due to their hereditary nature and lifelong impact. As such, the Foundation’s work emphasizes the genetic underpinnings of ASCVD, promoting screening cascades within families to detect at-risk individuals earlier and implement preventative strategies. This cascade testing paradigm represents a shift towards precision cardiology, where genetic profiling informs individualized management plans to curb premature cardiovascular morbidity and mortality.

Overall, the Lp(a) AW(a)RE initiative represents a critical, timely response to a significant public health challenge. By enhancing awareness, streamlining screening protocols, and advocating for systemic policy change, the program endeavors to recalibrate cardiovascular risk assessment standards nationally. The synergistic partnership with pharmaceutical innovators, healthcare providers, and policymakers promises to accelerate clinical translation of Lp(a) science and ultimately improve patient outcomes.

The Family Heart Foundation invites physicians, insurers, policy leaders, and the public to engage actively in this multi-year campaign. As new diagnostic tools, therapeutic options, and educational materials continue to evolve, the Foundation remains committed to demystifying the complexities of elevated lipoprotein(a) and reducing the global burden of inherited cardiovascular disease.

Subject of Research: Genetic Dyslipidemias and Lipoprotein(a) in Cardiovascular Disease
Article Title: Family Heart Foundation Launches Lp(a) AW(a)RE Initiative to Transform Cardiovascular Risk Screening and Diagnosis
News Publication Date: November 4, 2025
Web References:
– Family Heart Foundation: https://familyheart.org/
– Research on Lp(a): https://pubmed.ncbi.nlm.nih.gov/27998826/
Keywords: Lipoprotein(a), Lp(a), Cardiovascular Disease, Genetic Dyslipidemia, Atherosclerotic Cardiovascular Disease, Familial Hypercholesterolemia, LDL Cholesterol, Cardiovascular Risk Screening, Health Care Policy, Patient Advocacy, Health Equity, Primary Care