Current Atherosclerosis Reports

, Volume 14, Issue 2, pp 140–149 | Cite as

Coronary Heart Disease in Young Adults

  • Jessica B. Rubin
  • William B. BordenEmail author
Coronary Heart Disease (J Farmer, Section Editor)


Despite the recent decline in mortality from coronary heart disease (CHD), this disease remains the leading killer of US adults of all ages. CHD in young adults is not as well characterized as CHD in older individuals because it occurs less frequently, but this disease can have devastating consequences for young patients and their families. As in older adults, the majority of coronary events in young adults are related to atherosclerosis, and one or more of the traditional CHD risk factors is typically present. Young patients, however, are more likely than older patients to be smokers, male, obese, and to have a positive family history. Risk factor reduction is thus of major importance in managing young CHD patients. Approximately 20% of CHD in young adults, however, is related to non-atherosclerotic factors, such as coronary abnormalities, connective tissue disorders, and autoimmune diseases. Cocaine and other illicit drug use have been increasingly associated with acute myocardial infarction and accelerated atherosclerosis. The differences in etiologies and risk profiles of younger and older CHD patients result in differences in disease progression, prognosis, and treatment. Limited data suggest that prognosis may be better in the young population, although long-term mortality studies have suggested otherwise. Screening for CHD in the young population may help to improve prognosis in young patients by detecting subclinical disease, although more studies are necessary to establish reference limits for this young population. Additional research must also focus on treatment concerns that are specific to young patients.


Coronary heart disease Atherosclerosis Myocardial infarction Young adults Risk factors 



J.B. Rubin: none; W.B. Borden participated in a one-time advisory board meeting for Kowa Company, Ltd.


Recently published papers of interest have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, Camethon MR, Dai S, de Simone G, Ford ES, et al. Heart disease and stroke statistics-2011 update a report from the American heart association. Circulation. 2011;123(4):E18–E209.PubMedCrossRefGoogle Scholar
  2. 2.
    • Arzamendi D, Benito B, Tizon-Marcos H, Flores J, Tanguay JF, Ly H, Doucet S, Leduc L, Leung TK, Campuzano O et al: Increase in sudden death from coronary artery disease in young adults. Am Heart J 2011, 161(3):574–580. This is one of the most recent autopy studies to examine the current distribution of causes of sudden cardiac death in a young population and to examine in further detail the characteristics of patients who died of coronary artery disease. PubMedCrossRefGoogle Scholar
  3. 3.
    Drory Y, Turetz Y, Hiss Y, Lev B, Fisman EZ, Pines A, Kramer MR. Sudden unexpected death in persons less than 40 years of age. Am J Cardiol. 1991;68(13):1388–92.PubMedCrossRefGoogle Scholar
  4. 4.
    Yater WM, Traum AH, et al. Coronary artery disease in men 18 to 39 years of age; report of 866 cases, 450 with necropsy examinations. Am Heart J. 1948;36(3):334. passim.PubMedCrossRefGoogle Scholar
  5. 5.
    Jalowiec DA, Hill JA. Myocardial infarction in the young and in women. Cardiovasc Clin. 1989;20(1):197–206.PubMedGoogle Scholar
  6. 6.
    Hosseini SK, Soleimani A, Karimi AA, Sadeghian S, Darabian S, Abbasi SH, Ahmadi SH, Zoroufian A, Mahmoodian M, Abbasi A. Clinical features, management and in-hospital outcome of ST elevation myocardial infarction (STEMI) in young adults under 40 years of age. Monaldi Arch Chest Dis. 2009;72(2):71–6.PubMedGoogle Scholar
  7. 7.
    Bajaj S, Shamoon F, Gupta N, Parikh R, Parikh N, Debari VA, Hamdan A, Bikkina M. Acute ST-segment elevation myocardial infarction in young adults: who is at risk? Coron Artery Dis. 2011;22(4):238–44.PubMedCrossRefGoogle Scholar
  8. 8.
    Panduranga P, Sulaiman K, Al-Zakwani I, Abdelrahman S. Acute coronary syndrome in young adults from Oman: results from the gulf registry of acute coronary events. Heart Views. 2010;11(3):93–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Hong MK, Cho SY, Hong BK, Chang KJ, Mo-Chung I, Hyoung-Lee M, Wook-Lim S, Kwon HM, Jang YS, Chung NS, et al. Acute myocardial infarction in the young adults. Yonsei Med J. 1994;35(2):184–9.PubMedGoogle Scholar
  10. 10.
    Pineda J, Marin F, Roldan V, Valencia J, Marco P, Sogorb F. Premature myocardial infarction: clinical profile and angiographic findings. Int J Cardiol. 2008;126(1):127–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Morillas P, Bertomeu V, Pabon P, Ancillo P, Bermejo J, Fernandez C, Aros F. Characteristics and outcome of acute myocardial infarction in young patients. The PRIAMHO II study. Cardiology. 2007;107(4):217–25.PubMedCrossRefGoogle Scholar
  12. 12.
    •• McManus DD, Piacentine SM, Lessard D, Gore JM, Yarzebski J, Spencer FA, Goldberg RJ: Thirty-year (1975 to 2005) trends in the incidence rates, clinical features, treatment practices, and short-term outcomes of patients <55 years of age hospitalized with an initial acute myocardial infarction. Am J Cardiol 2011, 108(4):477–482. This is one of the only studies to examine recent, long-term trends in coronary heart disease in young adults using a large, US-based population. PubMedCrossRefGoogle Scholar
  13. 13.
    Doughty M, Mehta R, Bruckman D, Das S, Karavite D, Tsai T, Eagle K. Acute myocardial infarction in the young–the university of Michigan experience. Am Heart J. 2002;143(1):56–62.PubMedCrossRefGoogle Scholar
  14. 14.
    Cole JH, Miller 3rd JI, Sperling LS, Weintraub WS. Long-term follow-up of coronary artery disease presenting in young adults. J Am Coll Cardiol. 2003;41(4):521–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Lloyd-Jones DM, Leip EP, Larson MG, D’Agostino RB, Beiser A, Wilson PW, Wolf PA, Levy D. Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age. Circulation. 2006;113(6):791–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Strong JP, Malcom GT, McMahan CA, Tracy RE, Newman 3rd WP, Herderick EE, Cornhill JF. Prevalence and extent of atherosclerosis in adolescents and young adults: implications for prevention from the pathobiological determinants of atherosclerosis in youth study. JAMA. 1999;281(8):727–35.PubMedCrossRefGoogle Scholar
  17. 17.
    McGill Jr HC, McMahan CA, Zieske AW, Tracy RE, Malcom GT, Herderick EE, Strong JP. Association of coronary heart disease risk factors with microscopic qualities of coronary atherosclerosis in youth. Circulation. 2000;102(4):374–9.PubMedGoogle Scholar
  18. 18.
    Tuzcu EM, Kapadia SR, Tutar E, Ziada KM, Hobbs RE, McCarthy PM, Young JB, Nissen SE. High prevalence of coronary atherosclerosis in asymptomatic teenagers and young adults: evidence from intravascular ultrasound. Circulation. 2001;103(22):2705–10.PubMedGoogle Scholar
  19. 19.
    Choudhury L, Marsh JD. Myocardial infarction in young patients. Am J Med. 1999;107(3):254–61.PubMedCrossRefGoogle Scholar
  20. 20.
    Chan MY, Woo KS, Wong HB, Chia BL, Sutandar A, Tan HC. Antecedent risk factors and their control in young patients with a first myocardial infarction. Singapore Med J. 2006;47(1):27–30.PubMedGoogle Scholar
  21. 21.
    •• Khawaja FJ, Rihal CS, Lennon RJ, Holmes DR, Prasad A: Temporal trends (over 30 years), clinical characteristics, outcomes, and gender in patients </=50 years of age having percutaneous coronary intervention. Am J Cardiol 2011, 107(5):668–674. This study compared the clinical characterisitics and outcomes patients under 50 years of age to older patients undergoing PCI at the Mayo Clinic from 1979 to 2007. This is one of the few studies looking at a population over a long enough time period to identify changes over time. PubMedCrossRefGoogle Scholar
  22. 22.
    Oliveira A, Barros H, Maciel MJ, Lopes C. Tobacco smoking and acute myocardial infarction in young adults: a population-based case–control study. Prev Med. 2007;44(4):311–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Schoenenberger AW, Radovanovic D, Stauffer JC, Windecker S, Urban P, Niedermaier G, Keller PF, Gutzwiller F, Erne P. Acute coronary syndromes in young patients: presentation, treatment and outcome. Int J Cardiol. 2011;148(3):300–4.PubMedCrossRefGoogle Scholar
  24. 24.
    Trzos E, Uznanska B, Rechcinski T, Krzeminska-Pakula M, Bugala M, Kurpesa M. Myocardial infarction in young people. Cardiol J. 2009;16(4):307–11.PubMedGoogle Scholar
  25. 25.
    Rallidis LS, Lekakis J, Panagiotakos D, Fountoulaki K, Komporozos C, Apostolou T, Rizos I, Kremastinos DT. Long-term prognostic factors of young patients (<or =35 years) having acute myocardial infarction: the detrimental role of continuation of smoking. Eur J Cardiovasc Prev Rehabil. 2008;15(5):567–71.PubMedCrossRefGoogle Scholar
  26. 26.
    Chen L, Chester M, Kaski JC. Clinical factors and angiographic features associated with premature coronary artery disease. Chest. 1995;108(2):364–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Colkesen AY, Acil T, Demircan S, Sezgin AT, Muderrisoglu H. Coronary lesion type, location, and characteristics of acute ST elevation myocardial infarction in young adults under 35 years of age. Coron Artery Dis. 2008;19(5):345–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Yildirim N, Arat N, Dogan MS, Sokmen Y, Ozcan F. Comparison of traditional risk factors, natural history and angiographic findings between coronary heart disease patients with age <40 and > or =40 years old. Anadolu Kardiyol Derg. 2007;7(2):124–7.PubMedGoogle Scholar
  29. 29.
    Cengel A, Tanindi A. Myocardial infarction in the young. J Postgrad Med. 2009;55(4):305–13.PubMedCrossRefGoogle Scholar
  30. 30.
    Wiesbauer F, Blessberger H, Azar D, Goliasch G, Wagner O, Gerhold L, Huber K, Widhalm K, Abdolvahab F, Sodeck G, et al. Familial-combined hyperlipidaemia in very young myocardial infarction survivors (< or =40 years of age). Eur Heart J. 2009;30(9):1073–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Malmberg K, Bavenholm P, Hamsten A. Clinical and biochemical factors associated with prognosis after myocardial infarction at a young age. J Am Coll Cardiol. 1994;24(3):592–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Bostom AG, Cupples LA, Jenner JL, Ordovas JM, Seman LJ, Wilson PW, Schaefer EJ, Castelli WP. Elevated plasma lipoprotein(a) and coronary heart disease in men aged 55 years and younger. A prospective study. JAMA. 1996;276(7):544–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Gambhir JK, Kaur H, Gambhir DS, Prabhu KM. Lipoprotein(a) as an independent risk factor for coronary artery disease in patients below 40 years of age. Indian Heart J. 2000;52(4):411–5.PubMedGoogle Scholar
  34. 34.
    Gazzaruso C, Garzaniti A, Buscaglia P, Bonetti G, Falcone C, Fratino P, Finardi G, Geroldi D. Association between apolipoprotein(a) phenotypes and coronary heart disease at a young age. J Am Coll Cardiol. 1999;33(1):157–63.PubMedGoogle Scholar
  35. 35.
    Emanuele E, Peros E, Minoretti P, Falcone C, D’Angelo A, Montagna L, Geroldi D. Relationship between apolipoprotein(a) size polymorphism and coronary heart disease in overweight subjects. BMC Cardiovasc Disord. 2003;3:12.PubMedCrossRefGoogle Scholar
  36. 36.
    Gambhir JK, Kaur H, Prabhu KM, Morrisett JD, Gambhir DS. Association between lipoprotein(a) levels, apo(a) isoforms and family history of premature CAD in young Asian Indians. Clin Biochem. 2008;41(7–8):453–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Zimmerman FH, Cameron A, Fisher LD, Ng G. Myocardial infarction in young adults: angiographic characterization, risk factors and prognosis (coronary artery surgery study registry). J Am Coll Cardiol. 1995;26(3):654–61.PubMedCrossRefGoogle Scholar
  38. 38.
    Wolfe MW, Vacek JL. Myocardial infarction in the young. Angiographic features and risk factor analysis of patients with myocardial infarction at or before the age of 35 years. Chest. 1988;94(5):926–30.PubMedCrossRefGoogle Scholar
  39. 39.
    Glover MU, Kuber MT, Warren SE, Vieweg WV. Myocardial infarction before age 36: risk factor and arteriographic analysis. Am J Cardiol. 1982;49(7):1600–3.PubMedCrossRefGoogle Scholar
  40. 40.
    Corrado D, Thiene G, Cocco P, Frescura C. Non-atherosclerotic coronary artery disease and sudden death in the young. Br Heart J. 1992;68(6):601–7.PubMedCrossRefGoogle Scholar
  41. 41.
    Dao CN, Tobis JM. PFO and paradoxical embolism producing events other than stroke. Catheter Cardiovasc Interv. 2011;77(6):903–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Ishikawa Y, Kawawa Y, Kohda E, Shimada K, Ishii T. Significance of the anatomical properties of a myocardial bridge in coronary heart disease. Circ J. 2011;75(7):1559–66.PubMedCrossRefGoogle Scholar
  43. 43.
    Vales L, Kanei Y, Fox J. Coronary artery occlusion and myocardial infarction caused by vasospasm within a myocardial bridge. J Invasive Cardiol. 2010;22(4):E67–9.PubMedGoogle Scholar
  44. 44.
    Takahashi K, Oharaseki T, Yokouchi Y. Pathogenesis of Kawasaki disease. Clin Exp Immunol. 2011;164 Suppl 1:20–2.PubMedCrossRefGoogle Scholar
  45. 45.
    Fukazawa R. Long-term prognosis of Kawasaki disease: increased cardiovascular risk? Curr Opin Pediatr. 2010;22(5):587–92.PubMedGoogle Scholar
  46. 46.
    Vrints CJ. Spontaneous coronary artery dissection. Heart. 2010;96(10):801–8.PubMedCrossRefGoogle Scholar
  47. 47.
    Coleman DL, Ross TF, Naughton JL. Myocardial ischemia and infarction related to recreational cocaine use. West J Med. 1982;136(5):444–6.PubMedGoogle Scholar
  48. 48.
    Westover AN, Nakonezny PA, Haley RW. Acute myocardial infarction in young adults who abuse amphetamines. Drug Alcohol Depend. 2008;96(1–2):49–56.PubMedCrossRefGoogle Scholar
  49. 49.
    Kolodgie FD, Wilson PS, Mergner WJ, Virmani R. Cocaine-induced increase in the permeability function of human vascular endothelial cell monolayers. Exp Mol Pathol. 1999;66(2):109–22.PubMedCrossRefGoogle Scholar
  50. 50.
    El-Menyar AA, El-Tawil M, Al Suwaidi J. A teenager with angiographically normal epicardial coronary arteries and acute myocardial infarction after butane inhalation. Eur J Emerg Med. 2005;12(3):137–41.PubMedCrossRefGoogle Scholar
  51. 51.
    Novosel I, Kovacic Z, Gusic S, Batelja L, Nestic M, Seiwerth S, Skavic J: Immunohistochemical detection of early myocardial damage in two sudden deaths due to intentional butane inhalation. Two case reports with review of literature. J Forensic Leg Med, 18(3):125–131.Google Scholar
  52. 52.
    Tanis BC, Bloemenkamp DG, van den Bosch MA, Kemmeren JM, Algra A, van de Graaf Y, Rosendaal FR. Prothrombotic coagulation defects and cardiovascular risk factors in young women with acute myocardial infarction. Br J Haematol. 2003;122(3):471–8.PubMedCrossRefGoogle Scholar
  53. 53.
    Egred M, Viswanathan G, Davis GK. Myocardial infarction in young adults. Postgrad Med J. 2005;81(962):741–5.PubMedCrossRefGoogle Scholar
  54. 54.
    Keeling D. Combined oral contraceptives and the risk of myocardial infarction. Ann Med. 2003;35(6):413–8.PubMedCrossRefGoogle Scholar
  55. 55.
    Chakhtoura Z, Canonico M, Gompel A, Scarabin PY, Plu-Bureau G: Progestogen-only contraceptives and the risk of acute myocardial infarction: a meta-analysis. J Clin Endocrinol Metab, 96(4):1169–1174.Google Scholar
  56. 56.
    Koniari I, Siminelakis SN, Baikoussis NG, Papadopoulos G, Goudevenos J, Apostolakis E. Antiphospholipid syndrome; its implication in cardiovascular diseases: a review. J Cardiothorac Surg. 2010;5:101.PubMedCrossRefGoogle Scholar
  57. 57.
    Cervera R, Piette JC, Font J, Khamashta MA, Shoenfeld Y, Camps MT, Jacobsen S, Lakos G, Tincani A, Kontopoulou-Griva I, et al. Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheum. 2002;46(4):1019–27.PubMedCrossRefGoogle Scholar
  58. 58.
    Gualtierotti R, Biggioggero M, Meroni PL: Cutting-edge issues in coronary disease and the primary antiphospholipid syndrome. Clin Rev Allergy Immunol 2011Google Scholar
  59. 59.
    Jain D, Halushka MK. Cardiac pathology of systemic lupus erythematosus. J Clin Pathol. 2009;62(7):584–92.PubMedCrossRefGoogle Scholar
  60. 60.
    Klein LW, Nathan S. Coronary artery disease in young adults. J Am Coll Cardiol. 2003;41(4):529–31.PubMedCrossRefGoogle Scholar
  61. 61.
    Moccetti T, Malacrida R, Pasotti E, Sessa F, Genoni M, Barlera S, Turazza F, Maggioni AP. Epidemiologic variables and outcome of 1972 young patients with acute myocardial infarction. Data from the GISSI-2 database. Investigators of the Gruppo Italiano per lo Studio Della Sopravvivenza nell’Infarto Miocardico (GISSI-2). Arch Intern Med. 1997;157(8):865–9.PubMedCrossRefGoogle Scholar
  62. 62.
    Klein LW, Agarwal JB, Herlich MB, Leary TM, Helfant RH. Prognosis of symptomatic coronary artery disease in young adults aged 40 years or less. Am J Cardiol. 1987;60(16):1269–72.PubMedCrossRefGoogle Scholar
  63. 63.
    Fournier JA, Cabezon S, Cayuela A, Ballesteros SM, Cortacero JA, Diaz De La Llera LS. Long-term prognosis of patients having acute myocardial infarction when </=40 years of age. Am J Cardiol. 2004;94(8):989–92.PubMedCrossRefGoogle Scholar
  64. 64.
    Goldberg RJ, McCormick D, Gurwitz JH, Yarzebski J, Lessard D, Gore JM. Age-related trends in short- and long-term survival after acute myocardial infarction: a 20-year population-based perspective (1975–1995). Am J Cardiol. 1998;82(11):1311–7.PubMedCrossRefGoogle Scholar
  65. 65.
    Holmes Jr DR, White HD, Pieper KS, Ellis SG, Califf RM, Topol EJ. Effect of age on outcome with primary angioplasty versus thrombolysis. J Am Coll Cardiol. 1999;33(2):412–9.PubMedCrossRefGoogle Scholar
  66. 66.
    Screening for coronary heart disease: recommendation statement. Ann Intern Med 2004;140(7):569–572.Google Scholar
  67. 67.
    Blair RE. Coronary artery disease in a young USAF pilot: screening for premature artherosclerosis. Mil Med. 2010;175(9):688–90.PubMedGoogle Scholar
  68. 68.
    Soteriades ES, Smith DL, Tsismenakis AJ, Baur DM, Kales SN. Cardiovascular disease in US firefighters: a systematic review. Cardiol Rev, 19(4):202–215.Google Scholar
  69. 69.
    Superko HR, Roberts R, Agatston A, Frohwein S, Reingold JS, White TJ, Sninsky JJ, Margolis B, Momary KM, Garrett BC, et al. Genetic testing for early detection of individuals at risk of coronary heart disease and monitoring response to therapy: challenges and promises. Curr Atheroscler Rep.Google Scholar
  70. 70.
    Rana JS, Rozanski A, Berman DS. Combination of myocardial perfusion imaging and coronary artery calcium scanning: potential synergies for improving risk assessment in subjects with suspected coronary artery disease. Curr Atheroscler Rep.Google Scholar
  71. 71.
    Yang EY, Nambi V. Ultrasound imaging of carotid intima-media thickness: an office-based tool to assist physicians in cardiovascular risk assessment. Curr Atheroscler Rep.Google Scholar
  72. 72.
    Falk E, Sillesen H, Muntendam P, Fuster V. The high-risk plaque initiative: primary prevention of atherothrombotic events in the asymptomatic population. Curr Atheroscler Rep.Google Scholar
  73. 73.
    Zeb I, Budoff MJ. MESA: The NIH-sponsored study that validates atherosclerosis imaging for primary prevention. Curr Atheroscler Rep.Google Scholar
  74. 74.
    Mahoney LT, Burns TL, Stanford W, Thompson BH, Witt JD, Rost CA, Lauer RM. Usefulness of the Framingham risk score and body mass index to predict early coronary artery calcium in young adults (Muscatine study). Am J Cardiol. 2001;88(5):509–15.PubMedCrossRefGoogle Scholar
  75. 75.
    Gidding SS, McMahan CA, McGill HC, Colangelo LA, Schreiner PJ, Williams OD, Liu K. Prediction of coronary artery calcium in young adults using the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) risk score: the CARDIA study. Arch Intern Med. 2006;166(21):2341–7.PubMedCrossRefGoogle Scholar
  76. 76.
    Ridker PM, Rifai N, Rose L, Buring JE, Cook NR. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med. 2002;347(20):1557–65.PubMedCrossRefGoogle Scholar
  77. 77.
    Speidl WS, Graf S, Hornykewycz S, Nikfardjam M, Niessner A, Zorn G, Wojta J, Huber K. High-sensitivity C-reactive protein in the prediction of coronary events in patients with premature coronary artery disease. Am Heart J. 2002;144(3):449–55.PubMedCrossRefGoogle Scholar
  78. 78.
    Pineda J, Marin F, Marco P, Roldan V, Valencia J, Ruiz-Nodar JM, Sogorb F, Lip GY. Premature coronary artery disease in young (age <45) subjects: interactions of lipid profile, thrombophilic and haemostatic markers. Int J Cardiol. 2009;136(2):222–5.PubMedCrossRefGoogle Scholar
  79. 79.
    Pineda J, Marin F, Marco P, Roldan V, Valencia J, Ruiz-Nodar JM, Romero DH, Sogorb F, Lip GY. The prognostic value of biomarkers after a premature myocardial infarction. Int J Cardiol, 143(3):249–254.Google Scholar
  80. 80.
    Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher GF, Froelicher VF, Mark DB, McCallister BD, Mooss AN, O’Reilly MG, et al. ACC/AHA 2002 guideline update for exercise testing: summary article: a report of the American college of cardiology/American heart association task force on practice guidelines (committee to update the 1997 exercise testing guidelines). Circulation. 2002;106(14):1883–92.PubMedCrossRefGoogle Scholar
  81. 81.
    Piepgrass SR, Uhl GS, Hickman Jr JR, Hopkirk JA, Plowman K. Limitations of the exercise stress test in the detection of coronary artery disease in apparently healthy men. Aviat Space Environ Med. 1982;53(4):379–82.PubMedGoogle Scholar
  82. 82.
    Livschitz S, Sharabi Y, Yushin J, Bar-On Z, Chouraqui P, Burstein M, Eldad A. Limited clinical value of exercise stress test for the screening of coronary artery disease in young, asymptomatic adult men. Am J Cardiol. 2000;86(4):462–4.PubMedCrossRefGoogle Scholar
  83. 83.
    Taylor AJ, Bindeman J, Feuerstein I, Cao F, Brazaitis M, O’Malley PG. Coronary calcium independently predicts incident premature coronary heart disease over measured cardiovascular risk factors: mean three-year outcomes in the Prospective Army Coronary Calcium (PACC) project. J Am Coll Cardiol. 2005;46(5):807–14.PubMedCrossRefGoogle Scholar
  84. 84.
    Lee S, Choi EK, Chang HJ, Kim CH, Seo WW, Park JJ, Sang Il C, Chun EJ, Chang SA, Kim HK, et al. Subclinical coronary artery disease as detected by coronary computed tomography angiography in an asymptomatic population. Korean Circ J, 40(9):434–441.Google Scholar
  85. 85.
    •• Nambi V, Chambless L, Folsom AR, He M, Hu Y, Mosley T, Volcik K, Boerwinkle E, Ballantyne CM. Carotid intima-media thickness and presence or absence of plaque improves prediction of coronary heart disease risk: the ARIC (Atherosclerosis Risk In Communities) study. J Am Coll Cardiol, 55(15):1600–1607. This study followed a large number of patients over approximately 15 years. The results suggested that CIMT combined with plaque information can provide additional CHD risk prediction in addition to traditional risk factors. Google Scholar
  86. 86.
    Tzou WS, Douglas PS, Srinivasan SR, Bond MG, Tang R, Li S, Chen W, Berenson GS, Stein JH. Distribution and predictors of carotid intima-media thickness in young adults. Prev Cardiol. 2007;10(4):181–9.PubMedCrossRefGoogle Scholar
  87. 87.
    Mowatt G, Cook JA, Hillis GS, Walker S, Fraser C, Jia X, Waugh N. 64-Slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis. Heart. 2008;94(11):1386–93.PubMedCrossRefGoogle Scholar
  88. 88.
    Choi EK, Choi SI, Rivera JJ, Nasir K, Chang SA, Chun EJ, Kim HK, Choi DJ, Blumenthal RS, Chang HJ. Coronary computed tomography angiography as a screening tool for the detection of occult coronary artery disease in asymptomatic individuals. J Am Coll Cardiol. 2008;52(5):357–65.PubMedCrossRefGoogle Scholar
  89. 89.
    Kofflard MJ, de Jaegere PP, van Domburg R, Ruygrok P, van den Brand M, Serruys PW, de Feyter PJ. Immediate and long-term clinical outcome of coronary angioplasty in patients aged 35 years or less. Br Heart J. 1995;73(1):82–6.PubMedCrossRefGoogle Scholar
  90. 90.
    Shiraishi J, Shiraishi H, Hayashi H, Sawada T, Tatsumi T, Azuma A, Matsubara H. Interventional treatment for very young adults with acute myocardial infarction. Clinical manifestations and outcome. Int Heart J. 2005;46(1):1–12.PubMedCrossRefGoogle Scholar
  91. 91.
    McCord J, Jneid H, Hollander JE, de Lemos JA, Cercek B, Hsue P, Gibler WB, Ohman EM, Drew B, Philippides G, et al. Management of cocaine-associated chest pain and myocardial infarction: a scientific statement from the American heart association acute cardiac care committee of the council on clinical cardiology. Circulation. 2008;117(14):1897–907.PubMedCrossRefGoogle Scholar
  92. 92.
    Cohen DJ. Disappointing results of coronary artery bypass graft surgery in young patients. Chest. 1988;94(6):1124–5.PubMedCrossRefGoogle Scholar
  93. 93.
    Kelly ME, DeLaria GA, Najafi H. Coronary artery bypass surgery in patients less than 40 years of age. Chest. 1988;94(6):1138–41.PubMedCrossRefGoogle Scholar
  94. 94.
    Stone GW, Ligon RW, Rutherford BD, McConahay DR, Hartzler GO. Short-term outcome and long-term follow-up following coronary angioplasty in the young patient: an 8-year experience. Am Heart J. 1989;118(5 Pt 1):873–7.PubMedCrossRefGoogle Scholar
  95. 95.
    Glazier JJ, Piessens J, Vergauwen B, Stammen F, Vrolix MC, De Geest H, Willems JL. Outcome following coronary balloon angioplasty in young adults aged 35 years or less. J Interv Cardiol. 1991;4(1):13–9.PubMedCrossRefGoogle Scholar
  96. 96.
    Webb JG, Myler RK, Shaw RE, Anwar A, Stertzer SH. Coronary angioplasty in young adults: initial results and late outcome. J Am Coll Cardiol. 1990;16(7):1569–74.PubMedCrossRefGoogle Scholar
  97. 97.
    FitzGibbon GM, Hamilton MG, Leach AJ, Kafka HP, Markle HV, Keon WJ. Coronary artery disease and coronary bypass grafting in young men: experience with 138 subjects 39 years of age and younger. J Am Coll Cardiol. 1987;9(5):977–88.PubMedCrossRefGoogle Scholar
  98. 98.
    Fonarow GC, Watson KE. Effective strategies for long-term statin use. Am J Cardiol. 2003;92(A1):27i–34i.PubMedCrossRefGoogle Scholar
  99. 99.
    • Vuorio A, Kuoppala J, Kovanen PT, Humphries SE, Strandberg T, Tonstad S, Gylling H. Statins for children with familial hypercholesterolemia. Cochrane Database Syst Rev (7):CD006401. This Chochrane Systematic review focuses on the safety and efficacy of statins in children with familial hypercholesterolemia using eight randomized placebo-controlled trials. This review supported efficacy of these drugs but highlighted the lack of long-term safety data. Google Scholar
  100. 100.
    Stein EA, Illingworth DR, Kwiterovich Jr PO, Liacouras CA, Siimes MA, Jacobson MS, Brewster TG, Hopkins P, Davidson M, Graham K, et al. Efficacy and safety of lovastatin in adolescent males with heterozygous familial hypercholesterolemia: a randomized controlled trial. JAMA. 1999;281(2):137–44.PubMedCrossRefGoogle Scholar
  101. 101.
    James AH, Jamison MG, Biswas MS, Brancazio LR, Swamy GK, Myers ER. Acute myocardial infarction in pregnancy: a United States population-based study. Circulation. 2006;113(12):1564–71.PubMedCrossRefGoogle Scholar
  102. 102.
    Kealey A. Coronary artery disease and myocardial infarction in pregnancy: a review of epidemiology, diagnosis, and medical and surgical management. Can J Cardiol. 2010;26(6):185–9.PubMedCrossRefGoogle Scholar
  103. 103.
    Kazmin A, Garcia-Bournissen F, Koren G. Risks of statin use during pregnancy: a systematic review. J Obstet Gynaecol Can. 2007;29(11):906–8.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Weill Cornell Medical CollegeNew YorkUSA
  2. 2.Division of CardiologyWeill Cornell Medical CollegeNew YorkUSA

Personalised recommendations