Critical analyses of the ๐๐๐๐ (๐rogression of ๐arly ๐ubclinical ๐therosclerosis), ๐๐๐๐ (๐ulti-๐thnic ๐tudy of ๐therosclerosis), and ๐๐๐๐๐๐ (๐oronary ๐rtery ๐isk ๐evelopment ๐n Young ๐dults) studies highlight essential insights that advocate for a fundamental transformation in our approach to preventing myocardial infarction (MI) in young adults.
We must primarily focus on detecting ๐ฌ๐ฎ๐๐๐ฅ๐ข๐ง๐ข๐๐๐ฅ ๐๐ญ๐ก๐๐ซ๐จ๐ฌ๐๐ฅ๐๐ซ๐จ๐ฌ๐ข๐ฌ and shift from a broad “๐๐ญ-๐ซ๐ข๐ฌ๐ค ๐ฉ๐จ๐ฉ๐ฎ๐ฅ๐๐ญ๐ข๐จ๐ง” framework—which includes using a standard PCE-pooled cohort equation, conducting stress tests to identify provocable ischemia, and echocardiographic evaluations of regional wall motion abnormalities—to a more targeted assessment of “๐๐ญ-๐ซ๐ข๐ฌ๐ค ๐ข๐ง๐๐ข๐ฏ๐ข๐๐ฎ๐๐ฅ๐ฌ.”
A simple strategy incorporating examining lifestyle scores (HIS Score, Fuster- BEWAT score), coronary artery calcium (CAC) scores, and risk-enhancing factors can quickly identify “๐๐ญ-๐ซ๐ข๐ฌ๐ค ๐ฒ๐จ๐ฎ๐ง๐ ๐๐๐ฎ๐ฅ๐ญ๐ฌ.”
The “at-risk individuals” thus identified should proactively modify risk factors through healthy lifestyle transformation and “Guideline-Directed Medical Therapy” (GDMT). We must reassess our definitions of “๐ง๐จ๐ซ๐ฆ๐๐ฅ” ๐จ๐ซ “๐๐๐๐๐ฉ๐ญ๐๐๐ฅ๐” values in cardiovascular health. In the future, we will also have to study and validate the independent predictive value of subclinical atherosclerosis
