Russian Journal of Cardiology · Sep 8, 2026

Coronary artery disease, ischemic heart disease in young adults: risk factors, prevention and treatment. Opinion on a problem

By Селезнев СВ

Coronary heart disease (CHD) in young people is underestimated despite its severe consequences. CHD is traditionally viewed as a disease of middle-aged and elderly individuals, which is why it often remains undetected in young patients until an acute coronary event or sudden cardiac death occurs. Meanwhile, myocardial infarction at a young age has an extremely unfavorable long-term prognosis — in some studies, 15-year mortality reaches 45%, highlighting the serious medical and socioeconomic consequences. The article aims to raise clinicians’ awareness of the specifics of CHD in young patients. In addition to classic risk factors (smoking, family history, dyslipidemia, obesity, diabetes mellitus, arterial hypertension), specific causes are of particular importance in this population: familial dyslipidemias, elevated lipoprotein(a) levels, hypercoagulable states, congenital coronary artery anomalies, spontaneous coronary artery dissection, autoimmune diseases, as well as psychoactive substance use — cocaine, amphetamines and others, which can cause coronary artery spasm and acute coronary syndromes even in the absence of atherosclerosis. The authors emphasize the critical importance of early risk factor identification, medical follow-up, lifestyle modification, and timely initiation of preventive therapy. In individuals with multiple risk factors, additional risk stratification methods may be considered, including assessment of coronary calcium, lipoprotein(a), and high-sensitivity C-reactive protein. Treatment of acute and chronic forms of CHD in young patients generally follows standard clinical guidelines. In chronic myocardial ischemia, antianginal agents play an important role: beta-blockers, calcium channel blockers, ivabradine, as well as metabolic therapy with trimetazidine, which is particularly relevant when intensification of hemodynamically active therapy is limited.

doi.org/10.15829/1560-4071-2026-7100 Open access Interventions