Heart Attacks Increasingly Common in Young Adults

An alarming new study reveals an increase in heart attacks
are occurring men and women in their thirties and younger.  Youngest heart attack survivors have same
likelihood of dying as survivors 10+ years older; substance abuse may be
contributing to trend. 

Even
though fewer heart attacks are occurring in the U.S, these events are steadily
rising in very young adults. New data not only validate this trend but also
reveal that more heart attacks are striking those under age 40, according to
research being presented at the American College of Cardiology’s 68th
Annual Scientific Session.

The
study, which is the first to compare young (41-50 years old) to very young (40
or younger) heart attack survivors, found that among patients who suffer a
heart attack at a young age overall, 1 in 5 is 40 or younger. Moreover, during
the 16-year study period (2000 to 2016), the proportion of very young people
having a heart attack has been increasing, rising by 2 percent each year for
the last 10 years.

“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,” said Ron
Blankstein, MD, a preventive cardiologist at Brigham and Women’s Hospital,
associate professor at Harvard Medical School in Boston and the study’s senior
author. “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.”    

As
part of their analyses, Blankstein and colleagues tried to identify possible
risk factors behind the increase in heart attacks among younger adults. They
said that traditional risk factors for heart attack, including diabetes, high
blood pressure, smoking, family history of premature heart attack and high
cholesterol, were similar between the two groups. However, the youngest
patients were more likely to report substance abuse, including marijuana and
cocaine (17.9 percent vs. 9.3 percent, respectively), but had less alcohol use.

The
study included a total of 2,097 young patients (<50 years) admitted for a
heart attack in two large hospitals. Of these, 20 percent were 40 or younger.
Researchers compared young heart attack victims (<50 years vs. ≤40) using
patient angiograms, a procedure that uses X-rays to see the heart’s blood
vessels and arteries. People in the very young heart attack group were more
likely to have disease in only one vessel, suggesting that this disease was
still early and confined, yet they had the same rate of bad outcomes. The very
young group also had more spontaneous coronary artery dissection—a tear in the
vessel wall—which, while rare, tends to be more common in women, especially
during pregnancy.    

There
was a non-statistical trend toward less use of aspirin and statins upon
discharge among very young patients, which Blankstein said might suggest a bias
in terms of clinicians believing these patients are at lower risk because of
their age. However, data showed patients in both groups were at equal risk of
dying post-heart attack.

“It
all comes back to prevention,” Blankstein said. “Many people think that a heart
attack is destined to happen, but the vast majority could be prevented with
earlier detection of the disease and aggressive lifestyle changes and
management of other risk factors. My best advice is to avoid tobacco, get
regular exercise, eat a heart healthy diet, lose weight if you need to, manage
your blood pressure and cholesterol, avoid diabetes if you can, and stay away
from cocaine and marijuana because they’re not necessarily good for your
heart.”

Young
heart attack victims who also have diabetes fare much worse

In
a related study, Blankstein and his team found that 1 in 5 patients who suffer
a heart attack at a young age overall—defined as younger than 50 years of
age—also have diabetes. Data show that if someone has diabetes they are more
likely to die and have repeat events than heart attack survivors without
diabetes. Not only is diabetes one of the strongest risk factors for having a
heart attack, it also predicts future events in young people who have
previously had a heart attack. These patients need to be aggressively treated
and clinicians should pay very close attention to all other modifiable risk
factors.

The
good news, Blankstein said, is that there are now two classes of diabetes
medications that have also been shown in clinical trials to significantly
reduce the likelihood of cardiovascular events, including heart attack or
stroke, or dying from one.

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