Heart Attacks in Young Adults Are on the Rise; What To Do To Reduce Your Risk

If you think that you or a loved one is too young for a heart attack, think again.

Doctors across Yale New Haven Health (YNHHS) and the nation have been documenting a significant uptick in cardiac events impacting people in their 50s, 40s and even in their 30s and 20s. In one study cited in the Journal of the American Heart Association (JAHA), for example, data showed that the number of deaths after first hospitalization for a severe heart attack increased significantly among men and women ages 18-54 between 2011 to 2022. Women in that same age group were also more likely than men to die after a first heart attack.

The reasons for the increases are numerous, but the study cited by JAHA suggests that nontraditional factors are playing significant roles, with low income, kidney disease and drug use as examples.

Experts from Yale New Haven Health note that genetic factors and family history are always relevant, and obesity, diabetes, lack of exercise and other lifestyle factors (smoking, vaping, alcohol consumption) compound the odds of young people suffering heart attacks.

Significantly, individuals with multiple risk factors – an obese person who smokes, for example – do not face a “1+1=2” risk increase.

“The impact of risk factors like diabetes and obesity can lead to high cholesterol, high triglycerides, increased blood pressure and overall inflammation. These factors are interconnected with genetic factors, leading to an exponential increase for certain patients in risk for developing cardiovascular disease, including heart attack and stroke,” said Nikhil Sikand, MD, an advanced heart failure and transplant cardiologist with Yale New Haven Health, assistant professor, Cardiovascular Medicine, Yale School of Medicine, and medical director, Heart Transplant and Durable Mechanical Circulatory Support Programs at Yale Medicine.

What causes a heart attack?

Traditionally speaking, a heart attack – also known as a myocardial infarction, or injury to the heart muscle – is caused when plaque that has built up inside the walls of an artery ruptures, triggering a blood clot that blocks the artery and prevents oxygen-rich blood from reaching the heart muscle. Unless this blockage is quickly reopened with an emergency procedure, it can damage the heart muscle. A major arterial blockage can starve the heart of oxygen, leading to severe heart damage or death.

However, “while a blocked artery is typically what causes heart attacks, there are also other medical conditions that can cause damage to the heart muscle, and many of those conditions can affect younger folks,” Dr. Sikand said.

Early-onset coronary artery disease can affect young people with a family history of the condition, Dr. Sikand said, and a coronary event is all the more likely if people who already face genetic risks are heavy smokers, drug users, have adverse reactions to certain medications, or even if they’ve had a viral infection.

“We are also seeing instances of spontaneous coronary artery dissection and myocardial infarction in nonobstructive coronary disease,” Dr. Sikand said. “This means the patient does not have traditional blockages, but they are presenting with myocardial infarctions. And it tends to be women who present atypically.”

Myocarditis, an inflammation of the heart muscle in which people present with similar symptoms to heart attack, is another condition doctors have been seeing more often in recent years. “It’s actually from a massive amount of inflammation and damage to the heart muscle rather than blockages,” Dr. Sikand explained. “Myocarditis can cause weakening of the heart muscle or heart pump failure, and it can even affect teenagers or patients in their 20s or 30s.” Viral infections, certain medications and overactivity of the immune system can also cause myocarditis, he noted.

How to reduce your risk of heart attack

While behaviors can influence cardiovascular health, doctors note that many people are genetically prone to heart disease, which means it can sometimes be outside the control of an individual, even those who take good care of themselves. This is why it is always important to see a professional healthcare provider to assess your risk based on family history, genetics and lifestyle factors.

With that said, it is always beneficial to follow the basic heart healthy behavioral guidelines below:

Maintain a healthy weight: Maintaining a healthy weight is vital to good health. Doctors suggest a diet low in highly processed foods, saturated fats and carbohydrates, focusing instead on whole foods associated with the Mediterranean diet, which includes legumes, vegetables, fruits and nuts, olive oil (as opposed to butter) and lean proteins. “People who lose weight have less incidence of diabetes and other metabolic conditions that are all interrelated,” Dr. Sikand said.

Exercise: Exercise can help people maintain healthy weight and can strengthen the heart.

Dr. Sikand suggests people try to hit the American Heart Association’s recommended 150 minutes of exercise per week, which should include multiple sessions of cardiovascular exercise.

Don’t smoke: “Smoking remains one of the biggest modifiable risk factors for coronary artery disease,” Dr. Sikand said. “Also, we don’t have strong data on vaping yet, but we suspect that vaping may have elevated risk for health problems in general.”

Avoid alcohol: “We’re increasingly understanding that alcohol intake is related to adverse cardiovascular outcomes,” Dr. Sikand said. “Any amount is bad, but it’s particularly bad for patients who regularly drink large amounts of alcohol, multiple drinks a day. These are patients at risk not just for a heart attack but development of heart failure and failure of the heart muscle.”

See a doctor: The perceived invincibility of youth leads some people to avoid the doctor, but one of the most important steps a young person can take is to schedule an appointment with a provider to establish baseline information that can set the course for a healthier life as one ages.

Blood testing and/or diagnostic imaging can help identify cardiovascular risk factors when there is still time to modify some of those factors to help reduce the chance of cardiac events occurring later in life.

A lipid panel blood test can identify high cholesterol in a young person, for example, enabling corrective strategies if necessary. Additionally, doctors are increasingly recommending another type of blood test – a test for lipoprotein (a), also called Lp(a).

Similar in impact to "bad" LDL cholesterol, high levels of LP(a) are hereditary and do not change with diet or exercise. High LP(a) levels can dramatically increase a person’s plaque buildup, arterial inflammation, and risk of blood clots, which increases the risk of heart attack and stroke.

An imaging test called a coronary calcium scan may also help to identify those at risk. This test can identify hardened calcified plaques in coronary arteries, giving doctors a predictive tool for a patient’s likelihood of developing cardiovascular disease. Depending on one’s test results, medications or other interventions can be considered to mitigate risk.

“To summarize, there’s a large number of potential diseases outside of the traditional blocked arteries that can cause myocardial infarction, and many of these conditions can affect younger patients,” Dr. Sikand concluded. “We also know that there are many risk factors that can be modified with lifestyle changes and through testing and appropriate medication.”