Managing Atherosclerotic Cardiovascular Risk in Young Adults: JACC State-of-the-Art Review

Neil J. Stone, Sidney C. Smith, Carl E. Orringer, Nancy A. Rigotti, Ann Marie Navar, Sadiya S. Khan, Daniel W. Jones, Ronald Goldberg, Samia Mora, Michael Blaha, Michael J. Pencina, Scott M. Grundy

Research output: Contribution to journalReview articlepeer-review

48 Scopus citations


There is a need to identify high-risk features that predict early-onset atherosclerotic cardiovascular disease (ASCVD). The authors provide insights to help clinicians identify and address high-risk conditions in the 20- to 39-year age range (young adults). These include tobacco use, elevated blood pressure/hypertension, family history of premature ASCVD, primary severe hypercholesterolemia such as familial hypercholesterolemia, diabetes with diabetes-specific risk-enhancing factors, or the presence of multiple other risk-enhancing factors, including in females, a history of pre-eclampsia or menopause under age 40. The authors update current thinking on lipid risk factors such as triglycerides, non–high-density lipoprotein cholesterol, apolipoprotein B, or lipoprotein (a) that are useful in understanding an individual's long-term ASCVD risk. The authors review emerging strategies, such as coronary artery calcium and polygenic risk scores in this age group, that have potential clinical utility, but whose best use remains uncertain. Finally, the authors discuss both the obstacles and opportunities for addressing prevention in early adulthood.

Original languageEnglish (US)
Pages (from-to)819-836
Number of pages18
JournalJournal of the American College of Cardiology
Issue number8
StatePublished - Mar 1 2022


  • atherosclerotic cardiovascular disease
  • enhancing factors
  • family history of premature ASCVD
  • risk factor
  • young adults

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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