Dear Editor,
I recently read the article published in your journal, titled “Young Hearts at Risk: Unveiling Novel Factors in Myocardial Infarction Susceptibility and Prevention” authored by Ranjan et al.[1] With the increasing incidence of myocardial infarction in young adults, the article is properly timed and correctly highlights the contribution of plastics around us. The authors have wonderfully stressed the need to analyze the specific risk factors linked to young-onset acute myocardial infarction (AMI) as compared to older patients.
The article effectively highlights the significance of geographical factors and gender differences in contributing to the risk of MI in young patients. The authors have correctly highlighted the role played by non-conventional risk factors, such as the level of lipoprotein A, long COVID, and air pollution (micro- and nano-plastics) along with traditional risk factors such as dyslipidemia, in causing AMI in young adults. Thus, there arises a need for comprehensive screening of emerging cardiac biomarkers to assess the risk of developing AMI among young patients.
In the same context, I would like to propose that other risk factors such as serum homocysteine, heart-type fatty acid binding protein (hFABP), lipoprotein (a) (Lp (a)), ischemia-modified albumin (IMA), and hs CRP (high sensitive CRP), which can be easily measured in the clinical lab, should be incorporated while assessing the risk of AMI in young adults. A higher level of serum homocysteine results in inflammation, thrombosis, and fibrin formation, whereas alteration in levels of hFABP results in dysregulated fatty acid metabolism and inflammation. Various studies have shown that a deranged level of these biomarkers increases the risk of myocardial infarction (MI).[2,3]
With the availability of so many easily measurable biomarkers, there is a need to develop a risk predictive model that incorporates both conventional risk factors (such as age, sex, family history, and dyslipidemia) and non-conventional risk factors (such as long COVID, Lp a, homocysteine, and IMA). Such a predictive model would help in identifying high-risk individuals and guiding them about suitable lifestyle modification and preventive or therapeutic intervention.
The Framingham Heart Study model is such a well-established tool for predicting cardiovascular risk. However, with recent developments and increased access to measurable risks, a widespread population study is needed to develop a comparable model tailored to young adults.
Once again, I commend the authors for their thorough review of the risk factors associated with young-onset AMI. I firmly believe developing a predictive model would significantly increase the early identification of at-risk individuals.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
References
- 1.Ranjan A, Agarwal R, Mudgal SK, Bhattacharya S, Kumar B. Young hearts at risk: Unveiling novel factors in myocardial infarction susceptibility and prevention. J Family Med Prim Care. 2024;13:1200–5. doi: 10.4103/jfmpc.jfmpc_1639_23. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Thupakula S, Nimmala SSR, Ravula H, Chekuri S, Padiya R. Emerging biomarkers for the detection of cardiovascular diseases. Egypt Heart J. 2022;74:77. doi: 10.1186/s43044-022-00317-2. doi: 10.1186/s43044-022-00317-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Patibandla S, Gupta K, Alsayouri K. StatPearls. Treasure Island, FL: StatPearls Publishing; 2024. Cardiac biomarkers. 2023; Nov 17. [PubMed] [Google Scholar]