• hyperlipidaemias
• Global Burden of Disease

Coronary artery disease is a serious condition increasingly affecting young adults.1 2 Despite recent improvements in primary prevention of cardiovascular (CV) disease in older patients, identifying younger adults at risk of events who would benefit from an intensive preventive strategy remains challenging,3 even if they carry traditional, actionable cardiovascular risk factors. The Appraisal of risk Factors in young Ischaemic patients Justifying aggressive Intervention (AFIJI) study demonstrated that patients 45 years or younger with coronary artery disease carry a high burden of modifiable CV risk factors, including 77.3% of active smoking, 50.3% of dyslipidaemia and 20.3% hypertension.2 Despite this observation, a 2018 analysis of the YOUNG-MI registry showed that only 29%–49% of patients younger than 50 years with myocardial infarction without previous statin therapy would have met the criteria for statin eligibility according to the guidelines in effect at that time, indicating a potential gap between the estimated and the true CV risk in this age group.4

Recently, the high weight attributed to age alone in defining CV risk has been requestioned, and efforts have been made to refine these estimations in younger patients. In 2021, the European Society of Cardiology (ESC) revisited its risk prediction approach with the Systematic COronary Risk Evaluation (SCORE) 2 risk prediction algorithms.5 6 The SCORE2 model takes into account individualised inter-regional differences in risk, and was externally validated in combined cohorts including more than 1.1 million individuals.6 Two major limitations of the original SCORE models in predicting CV risk were addressed: calibration …