Cardiovascular Risk in Young Adults: A Narrative Review of Early Detection, Lifestyle Risk, Metabolic Syndrome, and Preventive Strategies

Cardiovascular disease is the leading cause of mortality and morbidity worldwide. Cardiovascular events are more likely to occur in the middle-aged and older population, but the process of atheroma or atherosclerosis often starts in adolescence and young adulthood. Traditional cardiovascular risk assessment tools mainly calculate 10-year risk and rely heavily on chronological age, which can lead to an underestimation of risk in younger adults who have been exposed for a longer period of time to modifiable cardiovascular risk factors, even if they have a high lifetime risk of atherosclerotic cardiovascular disease. This narrative review summarizes available evidence regarding the assessment and prevention of cardiovascular risk in young adults (defined for this review as individuals aged 18-39 years), with a particular focus on traditional cardiovascular risk factors, metabolic syndrome, cardiovascular risk specific to South Asians, lifetime cardiovascular risk estimation, modern cardiovascular risk prediction tools, and novel biomarkers that serve as important cardiovascular risk markers and risk enhancers such as lipoprotein(a), apolipoprotein B, inflammatory markers, and coronary artery calcium scoring. The review also addresses the shortcomings of the current short-term risk assessment, reviews the recent developments in the field of personalized cardiovascular risk stratification, and summarizes the evidence for lifestyle and pharmacologic preventive strategies relevant to clinical practice. There is current evidence in support of a life-course-based approach to cardiovascular prevention, which goes beyond age-based risk assessment and includes lifetime cardiovascular risk, cumulative exposure to cardiometabolic risk factors, and selected risk-enhancing factors when suitable. The most promising opportunity to prevent premature atherosclerotic cardiovascular disease is the early identification of at-risk individuals, aggressive lifestyle optimization, targeted pharmacological therapy according to current guidelines, and the follow-up of these individuals longitudinally. The shift to a more holistic and personalized approach to cardiovascular risk assessment could benefit the early prevention of cardiovascular disease and decrease its long-term burden—especially in high-risk groups like South Asians.