Background: Coronary artery disease is a catastrophic diseased, despite the recent decline in mortality, with improving facilities, more distressing if occurs in young, clearly because an otherwise healthy adult may die or become disabled without caution, besides the tragic consequences for the family, friends, and the job might be unexpected. The study aims to focus on these physically active groups and to get an idea about how to prevent them. Method: In a prospective study 365 patients with an acute coronary syndrome, of them, 117 adults age less than 50 years and 248 patient were above 50 yrs, underwent coronary angiography . were assessed comparatively for the contribution of many risk factors with the clinical and angiographic variable. Result: about one-third of cases who present with the acute coronary syndrome were more young, male, and smoker, with a family history of ischemic heart disease, more likely to had a myocardial infarction, rather than angina, usually single-vessel disease, with low high-density lipoprotein. Conclusion: In our study, we found a strong association with smoking, family history and low HDL with early ischemic heart disease. Abstinence from smoking with diet and exercise might help to improve these major risks. Screening for CHD in the young population may help to improve prognosis in young patients by detecting subclinical disease.