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<p>Premature coronary artery disease (PCAD) has emerged as a major public health concern in India, with onset occurring nearly a decade earlier than in Western populations and disproportionately affecting the young workforce. India bears a high burden of early-onset heart disease, driven by a complex interplay of genetic susceptibility, adverse dietary transitions, sedentary lifestyle, metabolic rearrangements, and socio-cultural determinants. This narrative review provides current evidence on the epidemiology, dietary and lifestyle factors, and mechanistic pathways underlying PCAD in Indian youth, highlighting the paradox of accelerated atherosclerosis despite comparatively modest elevations in traditional lipid markers. We examine how dietary patterns characterized by refined carbohydrates, trans fats, processed food, micronutrient deficiencies and erratic meal behaviours interact with metabolic risk factors such as dyslipidemia, obesity, hypertension, and diabetes mellitus to promote early endothelial dysfunction. Mechanistic insights are discussed with particular emphasis on dysregulation of one-carbon metabolism, oxidative stress, chronic inflammation, Apo B-mediated lipoprotein pathways, and epigenetic modifications that may predispose young Indians to premature atherosclerosis. The review also underscores gender specific vulnerabilities, underrepresentation of women in PACD research, and the contribution of familial and polygenic risk. We identify critical gaps in prevention, early screening, and evidence-based secondary care, and discuss future strategies, including personalized counselling and policy-level actions. Addressing PCAD in Indian youth requires a multidisciplinary approach combining mechanistic research, population-specific evidence, and public health interventions to safeguard the youth.</p>

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Youth at Risk: Decoding the Mechanistic Paradox of Early-Onset Heart Disease in India

  • 期刊论文

  • 发表日期：

    2026年3月25日

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  • Vidyavati HG,
  • Madhavi Reddy

摘要

Premature coronary artery disease (PCAD) has emerged as a major public health concern in India, with onset occurring nearly a decade earlier than in Western populations and disproportionately affecting the young workforce. India bears a high burden of early-onset heart disease, driven by a complex interplay of genetic susceptibility, adverse dietary transitions, sedentary lifestyle, metabolic rearrangements, and socio-cultural determinants. This narrative review provides current evidence on the epidemiology, dietary and lifestyle factors, and mechanistic pathways underlying PCAD in Indian youth, highlighting the paradox of accelerated atherosclerosis despite comparatively modest elevations in traditional lipid markers. We examine how dietary patterns characterized by refined carbohydrates, trans fats, processed food, micronutrient deficiencies and erratic meal behaviours interact with metabolic risk factors such as dyslipidemia, obesity, hypertension, and diabetes mellitus to promote early endothelial dysfunction. Mechanistic insights are discussed with particular emphasis on dysregulation of one-carbon metabolism, oxidative stress, chronic inflammation, Apo B-mediated lipoprotein pathways, and epigenetic modifications that may predispose young Indians to premature atherosclerosis. The review also underscores gender specific vulnerabilities, underrepresentation of women in PACD research, and the contribution of familial and polygenic risk. We identify critical gaps in prevention, early screening, and evidence-based secondary care, and discuss future strategies, including personalized counselling and policy-level actions. Addressing PCAD in Indian youth requires a multidisciplinary approach combining mechanistic research, population-specific evidence, and public health interventions to safeguard the youth.