Postponing AMI to 100 Years: An Emerging Concept

Acute myocardial infarction is a deadly disease, and in the Indian context, it occurs at a younger age, even below the age of 40 years, and sometimes even below 30 years. These young MI patients have high mortality rates, and many of them are not able to reach the hospital. The pathophysiology of AMI is very well understood. AMI is a multifactorial disease and has several risk factors, like dyslipidemia, diabetes, hypertension, smoking, diet, etc. However, low-density lipoprotein cholesterol (LDL-C) has a very strong causal relationship with atherosclerosis. Reducing LDL-C to <70 results in the arrest of the progression of atherosclerosis, and slashing its level to below 50 produces the regression of atherosclerosis. The cumulative exposure of LDL-C to the arterial wall is a very strong determinant of atherosclerosis and the development of AMI. The coronary heart disease (CHD) threshold target of LDL-C for the development of AMI is roughly 7000 mg/year. If LDL-C is 100 mg/dL from an early age, the CHD threshold target for the development of AMI will reach 70 years of age. However, if LDL-C target is <70 mg/dL from an early age, the patients will reach the CHD threshold of LDL-C at the age of 100 years. Based on the current science, this is an emerging concept to postpone AMI by several years, even up to 100 years. The goal of LDL-C <70 mg/dL can be achieved by available oral or injectable drugs. Gene editing with CRISPR technology is emerging as a very exciting modality for lowering LDL-C to a very low level for the rest of life.