Coronary artery disease (CAD) in young adults (aged<45 years old) encompasses a range of conditions affecting the coronary arteries, including atherosclerosis, vasospasm, inflammation, embolism, spontaneous dissection, aneurysm, physical or chemical injury, development, and abnormal drainage. Among these, coronary heart disease (CHD) resulting from coronary atherosclerosis is the most prevalent. This consensus addresses the current landscape of CAD in young adults, focusing on the epidemiology, risk factors, diagnosis, screening methods, and preventive strategies for young-onset coronary CHD. It particularly emphasizes the critical importance of early screening. Routine tests-including lipid profiles, blood glucose levels, and renal function assessment-are recommended for specific high-risk populations (e.g., individuals with family history of premature CHD, metabolic syndrome, chronic immune-mediated inflammatory diseases, or impaired renal function). Genetic testing (e.g., for familial hypercholesterolemia-related genes) should also be incorporated for risk assessment. Prevention strategies center on lifestyle interventions, such as adopting a low-salt, low-fat diet; engaging in regular physical activity; smoking cessation; limiting alcohol intake; maintaining good sleep hygiene; and minimizing exposure to air pollution. Additionally, guideline-directed management of dyslipidemia, hyperglycemia, hyperhomocysteinemia, and hypertension is recommended. For patients with comorbidities such as chronic kidney disease (CKD) or chronic immune-mediated inflammatory diseases, multidimensional biomarker monitoring and targeted interventions are essential. The consensus highlights that current evidence on young-onset CHD remains limited. Future research should strengthen the evidence regarding risk stratification, optimal screening frequency, and effective treatment strategies. Through multidisciplinary collaboration and enhanced public education, the goal is to reduce the incidence and disease burden of CHD in this young population.