CORONARY ARTERY DISEASE IN A YOUNG ADULT: UNVEILING THE INTRICATE INTERPLAY OF RISK FACTORS

Abstract

Therapeutic Area: ASCVD/CVD Risk Factors Case Presentation: A 28-year-old male with a history of tobacco use and obesity presented to the emergency department with acute chest pain, nausea, vomiting, diaphoresis, and shortness of breath. Initial electrocardiogram (ECG) findings showed hyperacute T waves and ST elevations less than 1mm in various leads, concerning for an acute myocardial infarction (MI). Despite treatment with nitroglycerin, morphine, and aspirin, his pain persisted, and he was transferred to our facility for further evaluation. Subsequent ECGs and elevated troponin levels of 700 ng/L confirmed the diagnosis of ST-elevation MI (STEMI). Additionally, laboratory studies revealed a normal lipid profile, yet revealed a high lipoprotein-a (Lp-(a)) level of 216 mg/dL. Coronary angiography revealed a 99% sub-total occlusion of the left anterior descending artery, which was successfully treated with stent placement. Post-intervention, the patient was started on metoprolol, statin, and clopidogrel. Transthoracic echocardiography showed severe hypokinesis of multiple left ventricular walls with a reduced ejection fraction. He was then started on valsartan, and spironolactone. Patient was eventually discharged with close cardiology follow-up. Background: Symptomatic coronary artery disease (CAD) affecting individuals between 18-45 years of age is commonly referred to as young CAD. While this condition is relatively uncommon, recent decades have seen an increased incidence among this age group. Traditional risk stratifications often underperform in young individuals, making early detection challenging. In this study, we present an interesting case involving a 28-year-old male who presented with an acute myocardial infarct. Conclusions: This case highlights the interplay of risk factors in the development of early-onset symptomatic CAD. Elevated Lp(a) levels, above 50mg/dL, have been correlated with an increased risk of cardiovascular disease, suggesting the potential importance of screening for elevated Lp(a) to identify individuals who may benefit from more aggressive lipid therapy and cardiovascular disease risk management. However, this process warrants further study. A comprehensive approach that considers both traditional and novel risk factors can potentially be effective management and prevention of CAD in younger individuals.