Early onset coronary artery disease (CAD) in individuals under 45 years old presents unique challenges, with prevalence rates of 1-2% generally, and as high as 5-10% among South Asian populations. With marked lifestyle changes and high caloric diet contributing to early occurrence of cardiovascular risk factors and associated smoking have increased the prevalence of CAD in this young population. Previous prospective long-term registries of young CAD patients in developed countries have shown it be a chronic aggressive disease with higher recurrent major adverse cardiac events (MACE) rates and worse long-term outcomes. Hence, we aim to explore the multi-faceted aspects of early onset CAD and its impact in ethnically diverse patient population.

This Research topic will focus only on early onset CAD in patients less than 45 years and study its epidemiology (CV risk factors, genetic and environmental factors), prevention (primary as well as secondary), clinical presentation (both chronic and acute coronary syndrome, ischemia related heart failure), management (non-invasive assessment including CT coronary angiogram, novel biomarkers, medical therapy, revascularisation strategies, intraprocedural coronary imaging characteristics) and subsequent clinical outcomes. Additionally, the study will scrutinize the disease's long-term impact and the effectiveness of various intervention strategies aimed at reducing its burden.

Research on early onset CAD will prioritize the following areas, with an emphasis on in-depth analyses tailored to patients under 45:
1. Epidemiology of early onset CAD:
- Role of emerging risk factors (e.g., metabolic disorders, inflammatory conditions,
psychosocial stress, drug abuse) and genetics in early onset CAD
- Disparities in the burden of early-onset CAD across different socioeconomic and
ethnic/racial groups
2. Acute coronary syndrome (ACS) in young patients
- Clinical and angiographic outcomes in young ACS patients
- Utility of advanced imaging techniques (Intravascular ultrasound, optical
coherence tomography) in young ACS
3. Chronic Coronary Syndrome (CCS) in young population
- Utility of early Non-invasive CAD screening (Exercise Tolerance Testing (ETT), CT-coronary calcium score & angiogram) in young patients
- Exploration of novel biomarkers or risk prediction models specific to young adults
with CAD
- Comparison of the efficacy and safety of different revascularization strategies
(percutaneous coronary intervention/ coronary artery bypass grafting) in
young patients.
- Exploration of the long-term outcomes and factors associated with disease
progression in young adults with CAD
4. Young individuals with ischemia related heart failure:
- Impact of timely revascularization and optimal medical management on the
prevention of heart failure in young CAD patients
- Ischemia related heart failure burden in young CAD patients and its outcomes
- Role of cardiac rehabilitation and lifestyle interventions in improving cardiac
function and heart failure outcomes in young CAD patients

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Frontiers in Cardiovascular Medicine

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