Young adults with multiple borderline metabolic abnormalities may face higher long-term cardiovascular (CV) risk despite being classified as low risk by conventional 10-year tools. A nationwide cohort study published in the European Journal of Preventive Cardiology evaluated 1,743,696 Korean adults aged 30–39 years who underwent national health screening in 2009.
Individuals with established hypertension, diabetes mellitus (DM), or dyslipidemia were excluded.

The analysis compared participants with coexisting pre-hypertension, pre-diabetes, and borderline dyslipidemia against those with none of these conditions. The primary endpoint combined myocardial infarction (MI), stroke, and cardiovascular (CV) death, with risks estimated using multivariable Cox proportional hazards models. 

Among 497,316 eligible participants, 44,553 (9.0%) had all three borderline conditions. Over a mean follow-up of 14.2 years, the composite endpoint was reported nearly twice as often in this group as in participants without these findings. After multivariable adjustment, the clustered pre-disease group remained associated with higher composite risk (adjusted hazard ratio [aHR], 1.23; 95% CI, 1.11–1.36).

The higher composite risk was largely related to increased rates of MI (aHR, 1.18) and stroke (aHR, 1.35), while all-cause mortality did not differ significantly. Results were consistent across body mass index (BMI), lifestyle behaviors, and lipid patterns. These findings suggest that young adults with coexisting borderline metabolic findings may merit earlier attention during long-term CV risk evaluation.