Heart disease is the No. 1 cause of death for men and women in the United States and now, researchers have discovered a troubling new trend: heart attacks are occurring more frequently in younger people.
A heart attack, also called a myocardial infarction, happens when a part of the heart muscle doesn't get enough blood. The more time that passes without treatment to restore blood flow, the greater the damage to the heart.
Recent research shows more heart attacks are striking those in the under 50 crowd.
According to data from the National Center for Health Statistics, the heart attack rate for young adults has increased by more than 66% over the past four years. In 2019, only 0.3% of U.S. adults between ages 18 and 44 had suffered a heart attack. Last year, that figure rose to 0.5% -- or one in 200. At the same time, rates in every other adult age group have declined since 2019.
A 2019 study found heart attacks in people under age 40 have been increasing over the past decade -- rising by 2% each year for the last 10 years. Now, 1 in 5 heart attack patients are younger than 40.
"It used to be incredibly rare to see anyone under age 40 come in with a heart attack — and some of these people are now in their 20s and early 30s," Dr. Ron Blankstein, preventive cardiologist at Brigham and Women's Hospital, said in a statement. "Based on what we are seeing, it seems that we are moving in the wrong direction."
Also, despite being 10 years younger on average than those having heart attacks in their 40s, very young patients have the same rate of adverse outcomes, including dying from another heart attack, stroke or any other reason.
"Even if you're in your 20s or 30s, once you've had a heart attack, you're at risk for more cardiovascular events and you have just as much risk as someone who may be older than you," Blankstein said, explaining that young age isn't necessarily protective. "It's really important for us to understand why people are actually having heart attacks at a younger age, when there is even more productive life lost."
Researchers have been trying to identify possible risk factors behind the increase in heart attacks among younger adults. They say that traditional risk factors -- including diabetes, high blood pressure, smoking, family history of premature heart attack and high cholesterol -- were similar between the two groups. The main difference researchers noted is that younger patients more often report substance abuse, including marijuana and cocaine.
COVID-19 may have also fueled the increase in premature heart attacks. SARS-CoV-2, the virus that causes COVID-19, can directly infect the arteries of the heart and cause the fatty plaque inside arteries to become highly inflamed, increasing the risk of heart attack and stroke, according to a study funded by the National Institutes of Health.
A data analysis from the Smidt Heart Institute at Cedars-Sinai also found that deaths from heart attacks rose significantly during pandemic surges. Furthermore, the data showed the increase was most significant among individuals ages 25-44.
In the year before the pandemic, there were 143,787 heart attack deaths; within the first year of the pandemic, this number had increased by 14% to 164,096. By the second year of the pandemic, the "observed" compared to "predicted" rates of heart attack death had increased by 29.9% for adults ages 25-44, by 19.6% for adults ages 45-64, and by 13.7% for adults age 65 and older.
One possible explanation is that COVID-19 may trigger or accelerate the presentation of preexisting coronary artery disease, even in younger adults. It could also be related to psychological and social challenges associated with the pandemic, including job loss and other financial pressures that can cause acute or chronic stress leading to cardiac disease.
In any event, researchers say the sharp rise in heart attack deaths is like nothing seen before.
"There is something very different about how this virus affects the cardiac risks," Susan Cheng, director of the Institute for Research on Healthy Aging in the Department of Cardiology at the Smidt Heart Institute, said in a statement. "The difference is likely due to a combination of stress and inflammation, arising from predisposing factors and the way this virus biologically interacts with the cardiovascular system."
While heart attacks are increasingly common in younger people, many don't believe they're at risk. A survey of more than 2,000 adults by The Ohio State University Wexner Medical Center found 47% of those under age 45 don't think they are at risk for heart disease.
"It is alarming that younger people don't feel that they're at risk for heart disease but it's not surprising," Dr. Laxmi Mehta said in a statement. "Most young people think heart disease only happens in old people but that's not the case."