Authors
S Vasudevan, Associate Editor, KMJ; Additional Professor, Department of Urology, Medical College, Trivandrum, Kerala, India.
Abstract
Background: Myocardial Infarction (MI), traditionally a disease of older adults, is increasingly recognized as an emerging and concerning problem among young Indian patients (defined as less than 45 years). This shift carries significant morbidity, psychological, and financial burdens.
Problem and Epidemiology: Despite declining CHD incidence in some Western populations, the prevalence of MI and its risk factors is rising in young adults and adolescents, especially among South Asians. Studies indicate a substantially higher incidence of premature MI in Indian populations compared to other ethnic groups, often presenting with more severe coronary abnormalities. Key contributing factors include increasing rates of smoking, hyperlipidemia, obesity, poor physical activity, consumption of junk food, metabolic syndrome, insulin resistance, and substance abuse. High levels of Lipoprotein(a) are also identified as an independent risk factor in South Asians.
Pathogenesis and Clinical Presentation: MI in young patients can stem from atheromatous, non-atheromatous, hypercoagulable causes, or substance abuse. Clinical presentation may deviate from the classic pattern, often featuring rapid progression from initial mild pain to severe MI.
Management and Prevention: While MI in younger patients can have a better prognosis with appropriate treatment, poor risk factor control significantly increases mortality. Secondary prevention is paramount, involving antiplatelet agents, statins, and rigorous lifestyle modifications such as smoking cessation, diabetes and lipid management, and obesity control.
Conclusion: The article underscores the urgent need for more research to elucidate the mechanisms behind the early onset and severity of CAD in young Indians. Effective secondary prevention measures are crucial for reducing long-term mortality in this vulnerable patient group.