ZenToks Publication

Chapter 2

Coronary Artery Disease in the Young

Abstract/Preface

Coronary artery disease (CAD) in individuals under 45 years represents a clinically distinct entity with escalating epidemiological burden, unique aetiological characteristics, and profound socioeconomic consequences. Although traditional atherosclerotic risk factor —smoking, hypertension, dyslipidaemia, and diabetes—account for approximately 85–90% of cases, younger patients present a distinct pathophysiological substrate characterised by positive vascular remodelling, lipid-rich vulnerable plaques, and a higher propensity for plaque rupture despite angiographically mild disease. Beyond conventional risk factors, genetic polymorphisms in lipoprotein metabolism genes, elevated lipoprotein(a), and an array of non-traditional factors including autoimmune disorders, infectious disease sequelae, and spontaneous coronary artery dissection contribute meaningfully to premature CAD. Approximately 5–15% of young myocardial infarction presentations occur without significant obstructive atherosclerosis, attributable instead to vasospasm, thromboembolism, or coronary dissection. Young MI survivors face substantially elevated recurrence risk and carry a higher burden of psychosocial morbidity than older cohorts, yet demonstrate significantly lower adherence to secondary prevention therapies. This chapter synthesises current epidemiological data, delineates the heterogeneous pathophysiological mechanisms underlying premature CAD, provides a systematic framework for comprehensive aetiological investigation, and outlines evidence-based management strategies encompassing acute intervention, long-term secondary prevention, and psychosocial support. Given that mortality from young CAD is not declining at rates observed in older populations, addressing the epidemic of premature atherosclerosis demands upstream public health intervention targeting modifiable risk factors whilst simultaneously ensuring rigorous individual-level clinical assessment and lifelong preventive therapy in young MI survivors.