An integrated early screening strategy including CPET identified previously undiagnosed subclinical cardiovascular abnormalities in over half of young adults, including 58% with reduced PeakVO2.
Observational (n=100)
Does an integrated early screening strategy including laboratory tests, echocardiography, and CPET detect subclinical cardiovascular changes in young adults with cardiometabolic risk factors?
An integrated screening approach incorporating CPET, echocardiography, and laboratory testing effectively identifies subclinical cardiovascular impairments in young adults with cardiometabolic risk factors who might otherwise be considered low-risk.
Abstract Introduction Over the past decade, a significant increase in cardiometabolic risk factors has been observed in individuals younger than 40 years, including obesity, arterial hypertension, and dyslipidemia. These changes contribute to accelerated atherosclerosis and the rising incidence of coronary artery disease (CAD) in younger adults. Despite this growing risk, systematic screening in this population is rarely performed, frequently resulting in delayed diagnosis. Aim To assess the utility and diagnostic value of early, integrated screening that includes laboratory analyses, echocardiography, and cardiopulmonary exercise testing (CPET) in young adults with cardiometabolic risk factors. Methods This prospective study included 100 patients aged 18–40 years with at least one cardiovascular risk factor (elevated BMI, hypertension, or dyslipidemia). All participants underwent: laboratory testing: lipid profile, glucose, HbA1c, and hs-CRP, Echocardiography: evaluation of left ventricular structure and function and detection of subclinical dysfunction; Ergospirometry (CPET): assessment of aerobic capacity and VO2 max as early markers of cardiovascular health. Results More than half of the participants demonstrated previously undiagnosed subclinical abnormalities. We observed interventricular septal thickening or mild left ventricular enlargement in 22%, elevated hs-CRP in 35%, and an atherogenic lipid profile in 41% of participants. The combined screening approach with CPET added more information to the early identification of cardiovascular strain in individuals who would otherwise be classified as "low risk." In 58% of participants, PeakVO2 was 85% of the predicted value, indicating an early decline in aerobic capacity despite normal ejection fraction and minimal structural cardiac changes and was common among participants with obesity, elevated triglycerides, and increased hs-CRP, allowing a more precise correlation between functional capacity and metabolic and inflammatory burden. Also, anaerobic threshold (VAT) in these patients provides the basis for prescribing targeted exercise interventions. Conclusion An integrated early screening strategy proves to be effective and justified for detecting subclinical cardiovascular changes in young adults. CPET allowed the objective quantification of true functional cardiovascular reserve, adding more information to laboratory tests and echocardiography, and revealed early functional impairments in young individuals who would otherwise be considered low-risk. Early identification of these abnormalities facilitates targeted interventions (more intensive lifestyle or exercise intervention, additional diagnostic evaluation, or routine monitoring within primary prevention programs), reduces long-term cardiovascular risk, and shifts the focus of preventive cardiology toward younger populations.
Nedeljkovic et al. (Mon,) conducted a observational in Cardiometabolic risk factors (n=100). Integrated early screening (laboratory, echocardiography, CPET) was evaluated on Detection of subclinical cardiovascular abnormalities. An integrated early screening strategy including CPET identified previously undiagnosed subclinical cardiovascular abnormalities in over half of young adults, including 58% with reduced PeakVO2.
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