Since entering the 21st century, the mortality rate of cardiovascular diseases in China has surpassed that of tumors, becoming the first killer that seriously endangers people’s health. Studies have found that the main causes of acute cardiovascular events are local atherosclerotic plaque rupture and thrombosis, the latter depends on the stability of the plaque, stable plaque may not produce any symptoms or only exertional angina, while unstable plaque can lead to sudden death, acute myocardial infarction and unstable angina. Most patients with acute myocardial infarction have extremely severe conditions. For patients with acute myocardial infarction, time is life and every second counts; the earlier it is detected the more ischemic myocardium can be saved, reducing the infarcted area and protecting the heart function. Therefore, it has become an urgent issue to accurately identify unstable plaques early before the occurrence of acute myocardial infarction events, predict the occurrence of myocardial infarction as early as possible and provide active and effective interventions. Can we really predict myocardial infarction and prevent it before it happens? Early warning system for myocardial infarction – the establishment of an early warning system for myocardial infarction In order to accurately determine the vulnerability of plaque, identify vulnerable patients early, and predict the occurrence of myocardial infarction, an early warning system including genetics, molecular markers, and imaging needs to be established. The establishment of an early warning system for the early identification of vulnerable plaques and vulnerable patients has attracted a lot of interest from scholars in China and abroad. Testing your genotype will tell you whether you will have coronary heart disease in the future. Genome-wide association studies of coronary heart disease have made some progress though. Our laboratory has identified NPR3 as a new strongly associated gene for coronary heart disease in Chinese population through genome-wide and candidate gene association analysis in a large sample of strictly selected coronary heart disease patients and control populations from all regions of China. This will not only help to understand the pathogenesis of coronary heart disease, but also help to develop individualized diagnosis and early warning. Our study also found that plasma BDNF levels were closely associated with the occurrence and prognosis of unstable angina, suggesting that BDNF has the potential to be an early warning indicator of unstable angina. In-depth studies have shown that the BDNFVal66Met gene polymorphism is closely associated with the occurrence of unstable angina. Our laboratory was the first to suggest that TRIB3 is a key link in the development of atherosclerosis risk factor clustering and that the TRIB3 R84 allele is an effective marker for early identification of high-risk individuals. Carotid plaque can also predict your chances of developing coronary heart disease. Carotid arteries are easily detectable body surface arteries and the morphology, size and nature of arterial plaque can be detected by carotid ultrasound. Carotid plaque detected by carotid ultrasound has been found to correlate well with coronary stenosis lesions detected by coronary angiography, and instability of carotid plaque predicts instability of coronary plaque, which in turn predicts the occurrence of myocardial infarction. Our study in patients with unstable angina found that carotid intima-media thickness was an independent predictor of coronary plaque rupture. We also proposed for the first time an association between carotid plaque morphology and ischemic stroke. Coronary enhancement CT is more visual to evaluate the coronary arteries. Electron beam computed tomography (EBCT) and spiral CT are the most accurate in quantifying the volume of calcification in the coronary arteries. Recently introduced non-EBCT systems, such as electrocardiogram-gated multi-row detector CT techniques, have a sensitivity and specificity of up to 90% for the evaluation of coronary stenosis and remodeling, and the quantification of plaque calcification volumes correlates well with EBCT. 64-row spiral CT has a high sub-second spatial resolution and can show pathological changes in the wall in addition to better determination of coronary lumen stenosis. In particular, it can clearly show the plaque density in the coronary artery wall and evaluate the plaque nature accordingly. According to the CT value, atheromatous plaques can be classified as soft plaques, fibrous plaques and hard plaques. Coronary CT is both accurate and convenient, and eliminates the invasive pain of coronary angiography for patients. Detection of sensitive inflammatory markers in the serum to predict plaque instability becomes possible. A large body of evidence suggests that the development of atherosclerosis is a chronic inflammatory process, and that acute inflammation of the plaque is a key factor leading to plaque rupture and promoting the development of acute myocardial infarction; the more active the inflammatory response, the more unstable the plaque is, and the inflammatory response is one of the most important intrinsic factors in plaque vulnerability. It was found that by detecting high-sensitivity C-reactive protein (hsC-RP), lipoprotein-related phospholipase A2, nuclear transcription factor NF-κB, fibrinogen, pregnancy-associated protein A, soluble adhesion molecules (sICAM-1, sP-selectin, sE-selectin, sVCAM-1), and chemokines (MCP-1, RANTES, and Fractalkine) have a very important role in predicting the occurrence and prognosis of acute myocardial infarction. Invasive techniques such as coronary angiography, intracoronary ultrasound, intracoronary angioscopy, laser coherence tomography (OCT) and intracoronary pressure and temperature guidewire techniques also offer a promising future for the identification of unstable plaques. The intravascular ultrasound (IVUS) technique makes up for the deficiency of traditional coronary angiography (CAG) which can only reflect the internal diameter of the vessel, and can accurately display the size and texture of the plaque, distinguish lipid-type, fibrous-type and calcified-type plaques according to the strength of the echo signal, and identify the calcium component particularly accurately, and show the rupture and ulceration of the plaque surface according to the continuity of the intimal echo. At present, IVUS technique has been widely used in clinical identification of plaque size and nature. A great deal of work has been done in our laboratory in the early identification of unstable plaques. We have proposed predictors of plaque rupture: a prospective study in a vulnerable plaque model in rabbits found that plaque eccentricity index, plaque area, serum hypersensitive CRP and plaque acoustic density were independent predictors of plaque rupture. Studies in patients with unstable angina found that carotid intima-media thickness, serum high-sensitivity CRP, and coronary remodeling index were independent predictors of coronary plaque rupture. Targeting risk factors and actively preventing coronary heart disease To reduce the morbidity and mortality of coronary heart disease, special attention should be paid to primary and secondary prevention of coronary heart disease. Early detection of risk factors and risk stratification are the focus of coronary heart disease prevention. While emphasizing lifestyle modification, pharmacotherapy has an important role for high-risk groups. In terms of pharmacological preventive treatment, primary prevention of aspirin should be given attention. The integration of antihypertensive drugs, statins and aspirin into a combination formulation can improve patient compliance. Therefore, we urgently need to raise public awareness of the risk of coronary heart disease and establish a scientific concept of coronary heart disease prevention and treatment through the efforts of doctors and the community. To actively prevent the occurrence of coronary heart disease, we should do the following in daily life: 1. Quit smoking: resolutely give up smoking and advocate scientific cessation of smoking. 2. Maintain normal and stable blood pressure, the ideal blood pressure is 120/80mmHg. measures to prevent and control hypertension include maintaining normal weight, limiting alcohol and salt intake, maintaining proper potassium, calcium and magnesium intake, and taking antihypertensive drugs under the guidance of a doctor. 3. Avoid mental stress. 5. A lifestyle of too little exercise is an important risk factor for coronary heart disease, regular exercise can help maintain body weight, reduce high blood pressure and hypertension, and the occurrence of coronary heart disease. 6. Diabetes, hyperlipidemia, etc.) of high-risk patients, it is recommended to take long-term aspirin and statins to prevent the occurrence of coronary heart disease.