Six-month changes in ideal cardiovascular health vs. Framingham 10-year coronary heart disease risk among young adults enrolled in a weight loss intervention

• Framingham 10-year risk of heart disease (FR-10) is often low (< 1%) in young adults.
• IDEAL, but not the FR-10, improved in most young adults in a weight loss trial.
• IDEAL could be more useful for detecting cardiovascular change in young adults.

The Framingham Risk equation uses sex, age, smoking, total cholesterol, high-density lipoprotein (HDL) cholesterol and systolic blood pressure to predict 10-year risk of coronary heart disease (FR-10). The American Heart Association's Ideal Cardiovascular Health (IDEAL) score uses smoking, total cholesterol, fasting glucose, blood pressure, body mass index (BMI), diet, and physical activity to encourage a healthy cardiovascular phenotype. This study aimed to compare 6-month changes in the FR-10 vs. IDEAL score among young adults with BMI ≥ 25 to < 40 kg/m2 enrolled in a behavioral weight loss intervention at the University of Pittsburgh (2010–12). Medians [25th, 75th percentiles] are reported. Weight decreased by 8 kg [− 12, − 4] among 335 participants. Of 7 possible points, IDEAL score was 4 [3, 4] at baseline, improved (i.e., increased) by 1 [0, 2] over 6 months, and improved in 64.2% and worsened in 6.6% of participants (p < 0.001). IDEAL classification of BMI, physical activity, total cholesterol, blood pressure and glucose improved (all p < 0.001), but not of smoking or diet (both p ≥ 0.05). FR-10 was < 1% at baseline for 88.1% of participants and changed in few participants (improved, i.e. decreased, in 7.5%, worsened in 1.8%, p < 0.001). Among young adults with overweight or obesity enrolled in a weight loss intervention, IDEAL detected positive changes in a majority of participants while the FR-10 did not. These findings suggest that IDEAL score may be more sensitive to positive cardiovascular health changes resulting from a behavioral intervention in this population.