In the study, a total of 6 patients were noted to have “either negative or insignificant levels of residual plaques” among the 79 patients in groups 1 and 2. These were patients who fell into the enigmatic category of acute myocardial infarction with healthy coronary arteries. This situation is the usual finding in very young (ie, teenaged) patients and is even more problematic in the absence of associated risk factors. These risk factors include a host of disease states, metabolic and endocrine disorders, illicit drug use, and coagulopathies. In some of these patients, coronary vasospasm is undoubtedly the mechanism involved in the production of the acute infarct, but this would not explain all cases. As the authors point out, a search for “novel risk factors” is needed, as these may be responsible for the development of premature coronary artery disease in young adults with optimal low-density lipoprotein cholesterol levels. The authors also mention “emerging risk factors such as homocysteine, lipoprotein (a), small dense LDL [low-density lipoprotein] and C-reactive protein.” One must also question the placement of C-reactive protein with this group, for its presence is not considered to be a primary risk factor, but one of a secondary nature that is initiated by some other abnormal state or process, and its “risks” are measured in association with other parameters.