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Improper posture over time primarily affects joint alignment. Adopting incorrect postural habits can lead to an imbalance, causing certain joints to become misaligned. This misalignment can result in added stress on the joints, ligaments, and surrounding tissues, potentially leading to discomfort, pain, and a decrease in overall mobility. The various changes in posture can also alter the distribution of forces across joints, contributing to degenerative changes.

Muscle flexibility, while it may be impacted by posture, is not the primary structure affected; rather, it’s the joints themselves that often suffer from direct consequences like misalignment. Similarly, the nervous system's efficiency is more related to how nerves transmit signals and less about joint positioning. Although cardiovascular health can be influenced by posture, particularly through changes in breathing patterns and the engagement of certain muscle groups during movement, it is not the most direct effect of long-standing postural deviations. Hence, joint alignment is the anatomical structure most significantly impacted by improper posture.