In reviewing data on more than 2,000 heart attack survivors age 50 and younger, scientists observed that the proportion of adults under 40 having heart attacks rose 2 percent every year between 2006 and 2016. “We found that approximately 20 percent of the heart attacks under the age of 50 are actually occurring in folks who are under the age of 40,” says the senior author, Ron Blankstein, MD, a preventive cardiologist at Brigham and Women’s Hospital and an associate professor at Harvard Medical School in Boston. “It used to be incredibly rare to see anyone under age 40 come in with a heart attack. Based on what we are seeing, it seems that we are moving in the wrong direction.”
Most Heart Attacks Can Be Avoided
Dr. Blankstein stresses that the majority of heart attacks happen to people who have underlying risk factors that can be completely prevented or treated. “For the most part, these are not heart attacks that are happening out of the blue,” he says. “They are happening in people who have underlying risk factors but sometimes don’t appreciate that they are at risk because they are young and think they may be invincible.” In both “young” heart attack patients age 41 to 50 and “very young” patients age 40 and under, researchers found the most common risk factor was cigarette use. Half the people who had heart attacks at a young age smoked. “Although smoking is declining in younger people, those who choose to smoke remain at high risk,” says Sarah Samaan, MD, a cardiologist with Baylor Scott & White Legacy Heart Center in Plano, Texas. Blankstein warns that growing use of e-cigarettes among young people is likely to cause more heart disease. “These products are not as benign as some young people believe,” he says. This investigation also highlighted high blood pressure, high cholesterol, and family history of premature heart attack as factors that can raise the likelihood of heart attack in this population.
Diabetes Can Worsen Outcomes
Blankstein notes that 20 percent of people who are having a heart attack at a young age have diabetes. Some of these individuals did not know they had the condition until they were hospitalized and tested after having a heart attack. Survivors with diabetes were more likely to have another heart attack or die. “Diabetes is certainly a risk factor for having a heart attack, and once you’ve had one, it’s a risk factor for having more health issues down the road,” he says. Blankstein attributes much of the rise in diabetes to an increase in obesity among Americans. “This has a lot to do with a lack of physical activity and an unhealthy diet,” he says. “There are a lot of factors like these that people can improve upon.” Two classes of diabetes medication may reduce the risk of heart attack and stroke, according to Blankstein. These are sodium-glucose cotransporter-2 inhibitors (such as canagliflozin, dapagliflozin, and empagliflozin) and glucagon-like peptide 1 receptor agonists (such as exenatide and liraglutide). “It’s exciting in cardiology that some of the medicines we use to treat diabetes actually lower your risk of heart disease events,” he says.
Drug Abuse Also Weakens the Heart
Compared with those over 40, the “very young” study subjects were more likely to report abusing substances such as marijuana and cocaine, although they consumed less alcohol. “Certain drugs, such as cocaine, can accelerate cholesterol buildup in the arteries of the heart and also cause the same arteries to spasm thereby causing a heart attack,” says Satjit Bhusri, MD, a cardiologist with Lenox Hill Hospital in New York City. Dr. Bhusri adds that the opioid crisis and the effects of substance abuse are also contributing to a rise in cardiovascular disease.
Heart Attacks Show No Age Discrimination
Patient angiograms (X-rays of blood vessels) revealed that the younger heart patients were more likely to have damage in only one vessel, suggesting that the disease was still early and confined. Still, the study found that the younger group of patients had a similar number of negative health outcomes as the older group. These included dying from another heart attack or stroke or any other reason. The very young group also had more incidents of spontaneous coronary artery dissection (a tear in the vessel wall). This is a rare condition that tends to be more common in women, especially during pregnancy. The investigation data suggests that the very young subjects were not using aspirin and statins as frequently after their heart attack. “I do wonder if sometimes physicians see younger people as low risk and are less likely to treat them with statins,” says Blankstein. “We’re seeing that if you have a heart attack at a young age, you are still at risk of more events, and we should not use your young age as a reason not to treat you aggressively.” Dr. Samaan says that the benefits of healthy habits cannot be emphasized enough. “Having a heart attack puts you at risk for heart failure and disability, and raises the cost of your healthcare,” she says. “Prevention in the form of healthy diet, exercise, avoiding toxic substances like tobacco and drugs, and maintaining a healthy body weight will go a long way toward keeping you healthy for the long term.”
