Emerging Trends in Atherosclerosis: Time to Address Atherosclerosis From a Younger Age

Two autopsy snapshots, two decades apart, anchor this review’s argument. Among adults aged 21 to 30, the share with coronary artery disease rose from 45% in the early 1990s to 85% by the early 2010s. Atherosclerosis, the authors argue, is arriving younger — and our prevention model hasn’t noticed.

The review builds a chain from diet to disease. Ultra-processed foods now supply roughly 58% of American calories, and the authors link that intake to sharply higher risks of obesity, hypertension, and diabetes — the metabolic soil in which early plaque grows. Crucially, they invoke the “cholesterol-years” principle: the same LDL exposure does more damage when it begins earlier, a lesson written plainly in familial hypercholesterolemia and echoed in the CARDIA cohort.

The structural failure they identify is the standard ASCVD risk calculator, validated only for ages 40 to 75 — which means the very window in which intervention would pay off most is the one the tools ignore. Their proposed response: screen high-risk younger adults, target ultra-processed food directly, and stop assuming prevention can wait. Reassuringly, they note plaque is modifiable — high-intensity interval training reduced plaque volume in one trial, and the DASH diet shifted plaques toward more stable forms.

The status-quo challenge — statins before 40 for some — is provocative and, by the authors’ own admission, unproven by randomized trials.

We rate the evidence on the higher side of moderate: a broad, well-referenced synthesis of autopsy, epidemiologic, and trial data, though published in a lower-tier journal and reliant on correlation for its central dietary claim. Its clinical significance scores high, because the trend it describes is alarming, the dietary target is actionable, and it presses a genuinely important question about when prevention should begin.