Abstract Body (Do not enter title and authors here): Introduction: Adverse childhood experiences (ACEs), usually measured retrospectively, are associated with long-term health. We examined associations of prospectively assessed ACEs with young-adult (YA) cardiovascular health (CVH). Methods: We included 1155 YAs with complete ACE assessments from baseline Y0 (birth), Y1, Y3, Y5, Y9, and who completed a CVH exam at Y22 in the FFCWS. An adversity score (AS) (range: 0-7) represented the number of ACE categories experienced by age 9 out of 7 ACE categories – emotional abuse and neglect; physical abuse and neglect; parental incarceration, parental substance use, and interpersonal violence. CVH was estimated using the Life’s Essential 8 (LE8) score (range: 0-100 points) overall and for each component, excluding sleep due to data unavailability. Linear regression models were adjusted for age and sex. Results: By age 9, 38% of YAs had experiences from 0-2 ACEs, 30% experienced 3, 21% experienced 4, and 11% experienced 5-7. People with higher ACE score were more likely to self-identify as Black compared to White, Hispanic, or other. In addition, higher AS correlated with lower BMI and higher nicotine use. Compared to individuals with a 0-2 AS, an AS of 4 was associated with a 3.6-point (CI: -6.5 to -0.7) lower (less favorable) LE8 score and an AS of 5-7 was associated with a 4.9-point (CI: -8.5 to -1.3) lower LE8 score. Among individual LE8 components, smoking and physical activity scores varied significantly by ACE score. Compared with an AS of 0-2, a score of 5-7 was associated with a 13.0-point (CI: -22.9 to -3.1) lower smoking score. For physical activity an AS of 4 and 5-7 were associated with a 12.1-point (CI: -21.8 to -2.3) and a 14.4-point (CI: -26.3 to -2.4) lower PA score, respectively. Conclusions: Higher level of childhood adversity at young ages were prospectively associated with lower LE8 scores and worse CVH in young adulthood. Understanding the prospective associations between childhood adversity and CVH can help identify higher risk populations and guide treatment recommendations.

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