Early-onset myocardial infarction: Risk factors and diagnostic challenges in young adults

Early-onset myocardial infarction (MI), defined as MI occurring in individuals under 45 years of age, is an emerging global health concern with unique epidemiological, clinical, and management challenges. Although less common than in older adults, its incidence has shown a recent upward trend, especially among young men and certain ethnic groups such as South Asians and African Americans. Traditional risk factors, including hypertension, diabetes mellitus, dyslipidemia, smoking, obesity, and family history, remain critical contributors, but emerging factors such as substance abuse, hypercoagulable states, inflammatory diseases, mental health disorders, sedentary lifestyle, and chronic infections also play significant roles. Genetic predispositions, notably familial hypercholesterolemia and polygenic risk variants including elevated lipoprotein (a), further amplify risk. Clinical presentation in young adults often deviates from classic patterns, with frequent atypical symptoms and gender-specific variations leading to diagnostic delays. Diagnostic challenges are compounded by underestimation of risk due to age, misclassification of symptoms, and disparities related to gender and ethnicity. Conventional diagnostic tools such as ECG and high-sensitivity troponins are invaluable but have limitations, while advanced imaging modalities, including cardiac computed tomography and magnetic resonance imaging, aid in complex cases. Existing risk stratification scores like thrombolysis in MI and Global Registry of Acute Coronary Events underperform in younger populations, highlighting the need for youth-specific predictive models incorporating genetic and psychosocial factors. Management parallels standard acute coronary syndrome protocols with emphasis on reperfusion, secondary prevention, lifestyle modification, medication adherence, psychosocial support, and cardiac rehabilitation tailored to younger patients’ needs. Prognosis is generally favorable, but recurrent events, psychological burden, and quality-of-life impairments persist. Future research must focus on developing refined risk assessment tools, early detection strategies, and personalized interventions to address the distinct pathophysiology and psychosocial context of young MI patients. Public health initiatives aimed at prevention and education are essential to curb the growing burden of early-onset MI worldwide.