Two worrying trends: Heart attacks in individuals under age 40 and in women are increasing

The good news is that overall heart attack rates are declining in the United States thanks to medications and lower smoking rates. The bad news is that the proportion of people having heart attacks under the age of 40 is increasing by 2% each year.

Having a heart attack before age 40 was previously considered unusual, said Bilal Ali, MD, a cardiologist with M Health Fairview. In the past decade, however, Ali has seen an increase in the number of acute myocardial infarctions among younger patients.

An acute myocardial infarction is a heart attack that occurs when blood flow to the heart is cut off – usually because of plaque buildup in the arteries. Researchers looking into why this is happening had a couple of interesting findings. First, risk factors like diabetes and hypertension are increasing in younger people. Second is an increase in smoking and drug use, particularly cocaine and marijuana.

Ali shares more areas of concern for cardiologists and what individuals can do to lower their risk.

Heart attacks in women are often unrecognized.

Heart attacks could look different in women than men, but they’re just as serious.

“The challenge has been the incidence has been increasing, but also the public awareness is lacking,” Ali said. “Although women experience similar symptoms as men do, such as chest discomfort and shortness of breath, there's also a higher rate of what we call atypical symptoms. Women may also have nausea, vomiting, and generalized fatigue. These aren’t symptoms that were commonly associated with heart attacks.”

It was previously assumed that the hormone estrogen helped protect women against heart attacks.

“That’s true to a degree,” Ali said, “but if you have multiple risk factors for coronary artery disease such as active tobacco use, diabetes and poorly controlled blood pressure, this protective effect is not absolute.

Heart attacks in women can also have another cause: spontaneous coronary artery dissection (SCAD), which is a tear in the lining of the coronary arteries. When this happens, it can cut off blood flow to the heart, causing a heart attack in a similar way to a plaque blockage. This happens particularly in women in their 30s and 40s who don’t have traditional risk factors for heart disease such as high blood pressure, high cholesterol or diabetes.

“The presentation is typically identical to someone having a traditional heart attack,” Ali said. “They come in with chest pain and elevated cardiac markers. The difference is the patient population. It’s typically young women who you wouldn’t expect to see coronary disease in.”

When doctors examine the cause, they often find a congenital abnormality in the lining of their blood vessels. Often, acute stress on the body, such as giving birth or heavy weightlifting may cause coronary artery dissection to occur.

The link between high-intensity activity and heart attacks.

Word has gotten out that shoveling can lead to heart attacks, even in young people. But it’s not just the strenuous activity and heavy lifting needed for snow removal.

“The problem is if you’re not somebody who is active on a regular basis. If you suddenly do intense exercise, that’s very likely to trigger an acute cardiac event like a heart attack.”

High intensity work first thing in the morning, particularly in cold temperatures when blood platelets are more reactive, can lead to blood clots that can cause a heart attack or stroke. Ali suggests warming up or starting exercise gradually. That might mean walking before running or using a snowblower rather than shoveling. If you don’t already have an exercise routine, it’s always a good time to talk to your doctor about starting one.

“I don’t want to discourage exercise, but I also don’t want somebody who doesn’t exercise regularly doing something at fairly high intensity at short notice,” Ali said.

How to lower your risk.

It’s almost universal that people who experience heart attacks have several, if not all, of the traditional risk factors of heart disease, including:

• Hypertension (high blood pressure)
• Diabetes
• Smoking
• Sedentary lifestyle (physical inactivity)
• High body weight

“Everyone should focus on what we know works in preventing heart attacks - maintaining a healthy diet, exercising at a moderate intensity at a minimum of 30 minutes, five days a week, not smoking, making sure you check your blood pressure, and checking your cholesterol at least once when your 30s,” Ali said.

Ali also recommends getting lipoprotein (a) checked along with your cholesterol panel. Lipoprotein (a) is genetically inherited and believed to increase risk of heart disease. If yours is elevated, you might benefit from meeting with a cardiologist who can monitor your health and help you reduce other risk factors as much as possible.

Atherosclerosis is the buildup of plaque in the arteries and heart. It’s an inflammatory process. You can reduce your risk with some lifestyle changes:

• Get 7-8 hours of sleep every day.
• If you smoke, quit.
• If you use drugs like cocaine or marijuana, quit.
• Get active for 150 minutes each week.
• Try to prioritize fruits, vegetables, and whole grains in your diet.

“You're eating three times a day, so that is the biggest exposure you have,” Ali said. “If you can adjust that to reduce your overall inflammatory and atherogenic risk, you will probably reduce your overall coronary artery disease risk more than prescription medications will.”