Introduction

Abstract

C oronary artery disease (CAD) is the leading killer and cause of disability in adults in the United States. It is estimated that by 2020, cardiovascular disease, particularly CAD, will become the most common cause of death worldwide. CAD is a manifestation of atherosclerosis, which is a systemic process. Many studies have documented the unsuspected presence of atherosclerosis in young individuals. Most recently, the Bogalusa Heart Study documented the presence of atheroma in young individuals killed by trauma,1 supporting data from older studies of Korean War and Vietnam War soldiers. In many patients, the diagnosis of CAD is not manifest until patients present with either an acute myocardial infarction (MI) or sudden cardiac death.2 The importance of early atherosclerosis on clinical events is documented in several studies. Autopsies documented that most MIs occur at lesion sites with minimal atherosclerosis, which are probably angiographically undetectable.3 The clinical significance of these early lesions is very similar to those of high-grade stenoses.4