Understanding Myocardial Infarction in Young Individuals Now or in 30 Years ?

We read with interest the study by An et al1 published in the Journal. Although the 30-year atherosclerotic cardiovascular disease score reclassified 1.6% of young adults with a higher cardiovascular risk, we question the use of long-term scores in this population.
Nationwide reports have demonstrated the increasing burden of cardiovascular disease in young adults.2 To improve cardiovascular prevention from a young age, observations from cohorts dedicated to premature coronary artery disease (CAD) with a long-term follow-up such as the AFIJI (Appraisal of Risk Factors in Young Ischemic Patients Justifying Aggressive Intervention) study should be taken into consideration.3 Scores do not include family history of CAD, although it is found in 50% to 60% of patients with premature CAD vs 25% in the overall CAD population. In AFIJI, risk enhancers such as ethnicity (South Asian, Sub-Saharan African) and chronic inflammation were specific to premature and fast-evolving CAD. The absence of a strong implementation of risk enhancers in the latest American College of Cardiology/American Heart Association and European Society of Cardiology guidelines could represent a missed opportunity for the detection of young patients at risk before their first myocardial infarction.

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