Table 2_Substance use in adolescence is associated with future cardiovascular disease risk: findings from the national longitudinal study of adolescent to adult health.docx

BackgroundSubstance use is a prevalent public health issue among adolescents in the United States (U.S.). While it’s a known risk factor for adult cardiovascular disease (CVD), the long-term impact of adolescent substance use on future CVD risk is understudied. This study aimed to (1) characterize substance use patterns in adolescents and (2) examine their association with future CVD risk.
MethodsWe performed a secondary analysis using Waves I and IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health) dataset. All analyses accounted for the Add Health multistage sampling design using survey procedures in SAS. In Wave I, adolescent substance use was evaluated through three self-report measures: binge drinking, marijuana use, and cigarette smoking. Substance use was defined in two ways: first, as mutually exclusive patterns (e.g., smoking only, smoking + binge drinking), and second, by the total number of substances used (0–3) to examine dose–response relationships. CVD risk in adulthood was measured using the 30-year Framingham CVD risk score and categorized as low or high. Using multiple logistic regression, we examined the association between substance use and CVD risk in adulthood, while adjusting for covariates.
ResultsThe final analytic sample comprised 4,128 participants with an average age of 15 years at baseline. About 26% of adolescents reported binge drinking, and a similar percentage (26%) reported smoking, while 13% used marijuana. Compared with adolescents who reported no substance use, those using one substance had 1.82 times higher odds of CVD in adulthood (95% CI: 1.47–2.25) after controlling for covariates. The odds increased to 2.38 times for two substances (95% CI: 1.74–3.25) and to 2.68 times for three substances (95% CI: 1.98–3.61). Adolescents using multiple substances, like smoking and binge drinking or all three substances, had higher odds of adult CVD compared to non-users.
ConclusionSubstance use in adolescence is strongly associated with elevated CVD risk in adulthood. These findings underscore the need to include substance use prevention and early intervention within broader initiatives to lower the CVD burden. Addressing substance use in young people may thus be a vital opportunity to reduce long-term cardiometabolic risks.

背景 物质使用在美国青少年群体中是一项普遍存在的公共卫生问题。尽管已知其为成人心血管疾病（Cardiovascular Disease, CVD）的危险因素，但青少年时期物质使用对未来心血管疾病风险的长期影响尚未得到充分研究。本研究旨在（1）刻画青少年的物质使用模式，（2）探讨其与未来心血管疾病风险的关联。
方法 本研究采用全国青少年到成人健康纵向研究（National Longitudinal Study of Adolescent to Adult Health, Add Health）数据集的第1波与第4波数据进行二次分析。所有分析均采用SAS软件的调查统计程序，以适配Add Health的多阶段抽样设计。在第1波调查中，通过三项自我报告测评工具评估青少年物质使用情况：暴饮（binge drinking）、大麻使用与吸烟。物质使用的定义分为两种方式：其一为互斥使用模式（如仅吸烟、吸烟+暴饮）；其二按使用物质的总种类数（0~3种）划分，以探讨剂量-反应关系。成人期心血管疾病风险采用30年弗雷明汉心血管疾病风险评分进行测量，并划分为低风险与高风险两类。本研究采用多元logistic回归分析，在校正混杂变量后，探讨青少年物质使用与成人期心血管疾病风险之间的关联。
结果 最终分析样本共纳入4128名参与者，基线时的平均年龄为15岁。约26%的青少年报告存在暴饮行为，相似比例（26%）的青少年报告吸烟，另有13%的青少年曾使用大麻。在校正混杂变量后，与无物质使用的青少年相比，使用1种物质的青少年成人期罹患心血管疾病的比值比为1.82（95%置信区间：1.47~2.25）。使用2种物质的青少年该比值比升至2.38（95%置信区间：1.74~3.25），使用3种物质的青少年则升至2.68（95%置信区间：1.98~3.61）。与无物质使用者相比，同时使用多种物质（如吸烟+暴饮，或同时使用三种物质）的青少年成人期心血管疾病风险更高。
结论 青少年时期的物质使用与成人期升高的心血管疾病风险存在显著关联。本研究结果凸显了需将物质使用预防与早期干预纳入降低心血管疾病负担的整体防控举措之中。因此，针对青少年群体的物质使用问题开展干预，或是降低长期心血管代谢风险的重要契机。