Revealing the Silent Threat: Cardiovascular Disease in Young Adults and the Pursuit of Preventive Measures Through the PRECAD Study

Cardiovascular disease is often considered a disease affecting older adults, given that the peak incidence is generally after the 6th decade of life. Given this, nearly all of the evidence regarding the prevention of cardiovascular disease is derived from patients middle-aged and older.

The idea of cardiovascular disease beginning early in life was first described in Vietnam war casualties, who showed evidence of cardiovascular disease upon autopsy despite being in their late teens and early twenties. The evidence supporting this notion has continued to grow, leading a group of experts to publish a timely review article in the Journal of the American College of Cardiology.

This research touched on several key points, including that chronic exposure to low-density lipoprotein cholesterol (LDL-C) and other cardiovascular risk factor mediators increases the prevalence of subclinical atherosclerosis in young adults (aged <40 years) and is associated with a greater risk of major adverse cardiovascular events later in life. The authors also highlight that the exposure to these risk factors, like elevated LDL and triglyceride levels, is cumulative, meaning that the number of years with elevated values is more important than a single isolated value.

Unfortunately, the optimal targets for risk factors like LDL and BP have not been established in young adults. Thus, health care professionals must identify optimal targets for these risk parameters needed to prevent incident cardiovascular disease.

The PRECAD study was designed to address this gap. PRECAD hypothesizes that maintaining very strict control of low-density lipoprotein, blood pressure, and glucose will prevent the onset of atherosclerosis in patients aged 20 to 39 years without cardiovascular disease. Of note, this trial will not evaluate actual rates of major adverse cardiovascular events but rather will evaluate changes in overall atherosclerosis burden.

Until the PRECAD study is published, treating cardiovascular risk factors in young adults must be done on a case-by-case basis. Young adults with certain high-risk features, like a strong family history of cardiovascular disease, may want to aggressively lower blood pressure and LDL values despite the current absence of evidence to support this approach.