Primary Prevention of Subclinical Atherosclerosis in Young Adults

Devesa A, Ibanez B, Malick WA, et al.
Primary Prevention of Subclinical Atherosclerosis in Young Adults: JACC Review Topic of the Week. J Am Coll Cardiol 2023;82:2152-2162.

The following are key points to remember from a review on primary prevention of subclinical atherosclerosis in young adults:

  1. There is increasing evidence that the atherosclerotic process that leads to symptomatic cardiovascular disease (CVD) starts at an early age.
  2. In young adults, exposure to low-density lipoprotein cholesterol (LDL-C) and other cardiovascular risk factor (CVRF) mediators, even at levels considered within normal limits, increases the prevalence of subclinical atherosclerosis and is associated with greater risk of CV events later in life.
  3. However, the optimal CVRF targets to prevent CVD in asymptomatic young individuals (<40 years) are unknown.
  4. The 30-year follow-up results of the CARDIA study have recently shown that not only does cumulative LDL-C exposure increase incident CVD risk, but similar relationships were demonstrated for exposure to triglycerides, mean arterial pressure, and pulse pressure exposure.
  5. The optimal CVRF targets in adults <40 years of age to avoid the development of atherosclerosis and CVD later in life must be established, and therapies known to reduce these CVRF must be shown to be effective in this age group.
  6. The randomized controlled PRECAD (Prevent Coronary Artery Disease) trial has been developed to assess the potential benefit of an aggressive control of CVRF in otherwise healthy young adults.
  7. The hypothesis of PRECAD is that in subjects aged 20-39 years without known CVD, maintaining LDL­C <70 mg/dL and strict control of blood pressure and glucose will prevent the onset of atherosclerosis and/or its progression.
  8. The primary endpoint is the progression of atherosclerosis burden measured by change in global plaque volume by three-dimensional volumetric ultrasound from baseline to 5 years after randomization.
  9. Specific measures will be implemented to achieve the following goals: LDL-C <70 mg/dL, SBP <120 mm Hg, and glycated hemoglobin <6.5%. Diet and lifestyle recommendations will be initiated in all patients as a first step; if the goal is not achieved, specific therapies will be implemented.
  10. The results may form the basis for new targets for CV risk modification for primary prevention of atherosclerosis in young adults.

Clinical Topics: Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins

Keywords: Atherosclerosis, Cholesterol, LDL, Primary Prevention

< Back to Listings