Because of misconceptions about what age-group is most at-risk for heart attacks, many people are surprised to discover that adults in their thirties and forties are frequently diagnosed with coronary artery disease. In West Los Angeles, including the Westside and parts of Santa Monica, there are many young professionals and students who should be aware of the following information.

What is Coronary Artery Disease?

Of the 1.4 million people hospitalized in the US each year for a heart attack, more than 250,000 are between 20 and 70 years of age. Women under the age of 50 account for roughly one-third of all heart attack cases each year. Of these women, one-quarter have coronary artery disease and 62% show no symptoms of the disease whatsoever. Other studies have shown that this current growth in the number of heart attacks among younger adults, and the rise in cases of coronary artery disease, have been increasing over the last twenty to thirty years.

According to recent national surveys, the percentage of 18 to 44 year old adults who have had a heart attack has increased from 0.3% in 2019 to 0.5% in 2023. The percentage for the older adult groups has decreased.

Even with this increase, having a heart attack under the age of 45 is still rare. However, we can see an increase in the wrong population, especially in people who think they are at low risk.

Many Traditional Risk Factors are Present

Generally speaking, there is usually at least one risk factor present.

Smoking is the largest contributor and is present in over 50% of the cases. Approximately 20% have diabetes. Obesity, high blood pressure, high cholesterol, and family history of early heart disease are present in the majority of cases as well.

Familiar Traditional Risk Factors are present in the majority of cases, and an inherited condition, such as familial hypercholesterolemia, is present in approximately 10% of the cases.

Cocaine use is also present in approximately 5% of the cases and use of marijuana is present in approximately 6% of the cases, especially in people under 40. Heart attacks in people under the age of 40 with no risk factors are caused by coronary artery disease and/or the use of cocaine.

Why Younger Patients Get Overlooked

Methods for assessing heart disease risk often skew toward older patients. As a result, younger patients with other risk factors of heart disease may be considered to have a lower risk. In fact, in one study, the large majority of patients under 50 years of age who suffered from a heart attack were not recommended to receive statin therapy as per the guidelines prior to their event.

Compared to the older population, younger adults undergo routine tests, such as a blood test to check their cholesterol levels, less often. When younger adults do experience symptoms of a heart attack, such as chest pain, they are more likely to attribute their symptoms to something else, such as indigestion or a strenuous workout. Healthcare professionals may also make the same assumption. As a result, a healthcare professional may not expect a blockage in a healthy-looking, younger patient.

There are also barriers that uniquely impact younger women that may contribute to heart disease. While the overall prevalence of heart attack among women under age 55 is relatively low, hospitalization data shows women under age 55 who experienced a heart attack are more often obese and suffering from other conditions, such as diabetes, high blood pressure, and kidney disease, compared to men of the same age who have a heart attack. Like women of all ages, women under 55 are more likely to experience heart disease and heart attacks and tend to report heart disease symptoms such as jaw, neck or arm pain, palpitations, shortness of breath, and other non-typical symptoms of a heart attack. Women are also more likely to have their healthcare professionals rule out a heart attack.

Young women have the highest incidence of Spontaneous Coronary Artery Dissection (SCAD). In the case of SCAD, the coronary artery wall is torn, and a heart attack occurs without the presence of blockages or plaque.

A younger body does not provide protection from the consequences of a heart attack.

With SCAD, a person suffers a heart attack at a relatively young age. Because of the SCAD, they also face the possibility of a subsequent heart attack, stroke and early death.

The good news from the study is that changes, especially if a person has quit smoking, can help improve the risk of future events.

What can a person in their 20’s, 30’s or 40’s do?

Have your cholesterol and blood sugar levels tested. Also, have your blood pressure checked and make sure you are not pre-hypertensive. Make an appointment to have all your numbers checked, especially if you are 40 or younger and have not done so previously.

Know your family history. It is important to let your doctor know if a family member had heart disease or other risk factors before the age of 55 (men) or 65 (women).

Stop using all tobacco products. Be upfront with your health care team about all of the drugs you are using.

Control your blood pressure and cholesterol levels, even if you feel healthy and well. Uncontrolled high blood pressure and high cholesterol can cause serious health problems over the years.

When to Seek Help

Dial 9-1-1 if you have chest pressure, discomfort, or tightness that lasts longer than a few minutes, especially if it is worsening and spreading to your arm, neck, jaw, and/or back. Shortness of breath, light headedness, nausea, or cold sweats can also indicate a medical emergency. Don’t take any chances and don’t let your age deceive you.

Ask your doctor to order tests to evaluate your heart if your recent family history includes early heart disease, you’re obese, you have diabetes, or you are over the age of 40 and have a high cholesterol.

Maria Tehrani, MD is a cardiac surgeon and graduate of Georgetown University School of Medicine. She practices throughout the greater Los Angeles area.

A history of cardiovascular disease in your family increases your chances of a cardiovascular incident, and preventing a cardiovascular event is always in your best interest.

Call the office of Maria Tehrani, MD, for an appointment.