Thread by @JACCJournals

(1/12) #JACC #Tweetorial: #cvCAD in Young Adults: A Hard Lesson, but a Good Teacher
✔️#AFIJI Cohort 20 year-follow-up: fal.cn/34s2J @ActionCoeur
✔️ Editorial: fal.cn/34s2K by @ErinMichos and @AChoiHeart

@ActionCoeur @ErinMichos @AChoiHeart @MichelZedBay @mathieukerneis @docjohanne @DrHulot_PARCC (2/12) #JACC #Tweetorial: The consequences of premature #cvCAD are devastating. Declines in ASCVD events have not extended to younger adults and rates have increased particularly among women 35-54 yrs old.

Arora, et al @CircAHA: fal.cn/34s2N

@ActionCoeur @ErinMichos @AChoiHeart @MichelZedBay @mathieukerneis @docjohanne @DrHulot_PARCC @CircAHA (3/12) #JACC #Tweetorial: In this issue Collet, JP, et al (@ActionCoeur) describe a cohort of 880 adults who experienced symptomatic #cvCAD at a young age (<45 years) presenting as obstructive CAD followed for up to 20 years. fal.cn/34s3H

@ActionCoeur @ErinMichos @AChoiHeart @MichelZedBay @mathieukerneis @docjohanne @DrHulot_PARCC @CircAHA (4/12) #JACC #Tweetorial: This study (#AFIJI registry) had the following objectives:
1⃣: Evaluate the rate of first recurrent MACE and associated risk factors
2⃣: Determine the relationship b/w the initial lesion and the new lesions
3⃣: Determine the rate of repeated recurrences

@ActionCoeur @ErinMichos @AChoiHeart @MichelZedBay @mathieukerneis @docjohanne @DrHulot_PARCC @CircAHA (5/12) #JACC #Tweetorial: At initial presentation, avg age 40 yrs; young smokers w a family history of #cvCAD or hyperlipidemia; 87% male, 10% w chronic inflammatory disease. During f/u, despite Rx of aspirin & statins, 1/3 of pts had recurrent MACE, and 36% had a second.

@ActionCoeur @ErinMichos @AChoiHeart @MichelZedBay @mathieukerneis @docjohanne @DrHulot_PARCC @CircAHA (6/12) #JACC #Tweetorial: Key findings:
✔️Recurrence rates high despite medical Rx
✔️Recurrent events generally occurred from new coronary lesions (non-obstructive plaques that progressed)
✔️48% with 1st recurrence not taking high-intensity statin
fal.cn/34s3H

@ActionCoeur @ErinMichos @AChoiHeart @MichelZedBay @mathieukerneis @docjohanne @DrHulot_PARCC @CircAHA (7/12) #JACC #Tweetorial: Additional findings:
✔️Factors associated w recurrence: insufficient control of conventional risk factors, multivessel disease, Sub-Saharan African ethnicity & inflammatory disease.
🚬Smoking was strongest modifiable risk factor
fal.cn/34s3H

@ActionCoeur @ErinMichos @AChoiHeart @MichelZedBay @mathieukerneis @docjohanne @DrHulot_PARCC @CircAHA (8/12) #JACC #Tweetorial: How to apply these results?
✔️Team-based and pt-centered to better implant guideline care
✔️Consider ezetimibe if LDL > 70 despite max statin
✔️Direct efforts to #cvPrev as per @ACCinTouch /@American_Heart 2019 guidelines. fal.cn/34s3V

@ActionCoeur @ErinMichos @AChoiHeart @MichelZedBay @mathieukerneis @docjohanne @DrHulot_PARCC @CircAHA @ACCinTouch @American_Heart (9/12) #JACC #Tweetorial: ID of which young, healthy adults are at risk is challenging. For example, in YOUNG-MI registry, most adults who presented w #cvAMI < age 50 ys would not have been guideline-eligible for statin therapy prior to events. fal.cn/34s42

@ActionCoeur @ErinMichos @AChoiHeart @MichelZedBay @mathieukerneis @docjohanne @DrHulot_PARCC @CircAHA @ACCinTouch @American_Heart @DLBHATTMD @AvinainderSingh @AnkurGuptaMD @Dr_Afatima (10/12) #JACC #Tweetorial: 2019 @ACCinTouch/@American_Heart guidelines identified “risk-enhancing factors” for adults 40-75 yrs . #AFIJI also observed ethnicity, inflammatory disease and smoking were major contributors to poor prognosis in young adults. fal.cn/34s46

@ActionCoeur @ErinMichos @AChoiHeart @MichelZedBay @mathieukerneis @docjohanne @DrHulot_PARCC @CircAHA @ACCinTouch @American_Heart @DLBHATTMD @AvinainderSingh @AnkurGuptaMD @Dr_Afatima @Donnakarnett @kellyarps @SethShayMartin @rblument1 (11/12) #JACC #Tweetorial: ID of atherosclerosis is paramount. By guidelines, for age 40-75, CAC by #YesCCT is reasonable to refine risk. While CAC generally not performed in age < 40, in multiple studies, CAC ranges 10-34% in young adults w ⬆️ risk. fal.cn/34s46

@ActionCoeur @ErinMichos @AChoiHeart @MichelZedBay @mathieukerneis @docjohanne @DrHulot_PARCC @CircAHA @ACCinTouch @American_Heart @DLBHATTMD @AvinainderSingh @AnkurGuptaMD @Dr_Afatima @Donnakarnett @kellyarps @SethShayMartin @rblument1 (12/12) #JACC #Tweetorial: The 🔑to aging well is to start young. Breaking the cycle of #cvCAD is going to take a multipronged approach. Let us learn from #AFIJI so history does not repeat itself for the next generation of young adults. fal.cn/34s48