The 'hidden' risk factors causing spike in deadly heart attacks as doctors urge people to know the signs
A blood clot in a hardened artery is the most common cause of a heart attack, but researchers have identified several other threats flying under the radar they say people need to know about. Doctors are trained to look for classic artery blockages, which are common in older patients with traditional risk factors, but this focus can cause them to miss the less common causes as these cases don't fit the expected pattern. The hidden causes often strike young, otherwise healthy individuals who do not fit the mold of a heart attack patient. A 15-year study by Mayo Clinic researchers revealed that more than half of heart attacks in younger people, especially women, are caused by 'nontraditional' factors, which means many underlying causes are going undetected and undiagnosed. Dr Claire Raphael, an interventional cardiologist at Mayo Clinic and first author of the study, said: ‘This research shines a spotlight on heart attack causes that have historically been under-recognized, particularly in women.‘When the root cause of a heart attack is misunderstood, it can lead to treatments that are less effective—or even harmful.’Some factors researchers discovered included an overworked heart caused by a severe illness like an infection or bleeding and a spontaneous tear in the artery wall. Researchers also found that a heart attack triggered by another severe illness is over four times more deadly at the five-year mark than a traditional heart attack caused by a clogged artery. Over half of heart attacks in young people, particularly women, stem from causes other than clogged arteries, such as the heart being overstressed by a severe infection or major bleeding (stock)
The researchers began by identifying every resident of Olmsted County, Minnesota, aged 65 or younger, who between 2003 and 2018 had a cardiac event accompanied by elevated heart injury markers; specific substances released into the bloodstream when the heart muscle is damaged such as a protein called troponin. Each case was individually reviewed, and heart attacks, medically called myocardial infarction (MI), were categorized into one of six specific causes.The causes included plaque rupture (atherothrombosis), spontaneous artery tear (SCAD), clot migration (embolism), artery spasm (vasospasm), non-obstructive causes (MINOCA-U) or oxygen supply-demand mismatch.Over time, cholesterol, fat, and plaque build up inside the artery wall, which is traditionally linked to high blood pressure, high cholesterol, smoking, diabetes and a family history of heart disease. When the plaque suddenly ruptures, it causes a blood clot to form that blocks the artery.Spontaneous coronary artery dissection (SCAD) is a sudden tear in the artery wall that is not related to plaque. It typically affects healthy young to middle-aged women and is often linked to hormonal shifts, like after childbirth or underlying genetic conditions that weaken connective tissues. Heart attacks among 18- to 44-year-olds increased 66 percent between 2019 and 2023, the most recent year for which data is availableEmbolism occurs when a blood clot forms elsewhere in the body, often due to an irregular heart rhythm like atrial fibrillation, and travels to block a heart artery.Other causes involve no permanent blockage at all. A coronary artery vasospasm is a temporary, severe squeezing of the artery that cuts off blood flow, often triggered by smoking, extreme stress, or stimulant drug use.Read More Key signs that sudden cardiac death is about to strike - even in totally healthy, fit young people Finally, a supply-demand mismatch (Type 2 MI) occurs when the heart is starved of oxygen due to a massive imbalance during extreme physical stress.The mismatch can occur during a severe infection, major bleeding, or a dangerously fast heart rate, where the heart’s need for oxygen vastly outstrips what its diseased arteries can supply, even without a rupture or clot.Over 15 years, Mayo researchers analyzed 4,116 heart injury events in 2,780 patients from their early 40s to their mid-60s, 68 percent were caused by plaque rupture. Heart attack rates were significantly lower in women, especially for plaque-related events. Still, spontaneous artery tears were 3.5 times more common in women and were misdiagnosed initially in 55 percent of them.While women with plaque-related heart attacks were similar in age to men and had comparable artery disease, they carried more risk factors. While clogged arteries were the top cause of heart attacks for both sexes, they were responsible for only 47 percent of cases in women versus 75 percent in men. This means over half of the heart attacks in women under 65 were due to other causes Non-plaque-related causes accounted for most heart attacks in women, 53 percent, compared to 25 percent in men.These included a supply-demand mismatch, which affected 34 percent of women versus 19 percent of men, and SCAD, which affected 11 percent of women versus 0.7 percent of men.The five-year death rate was highest after supply-demand mismatch events, with 33 percent dying before the end of that period, compared to eight percent for plaque-related attacks and zero percent for SCAD. Cardiovascular-specific mortality was low across all groups.Dr Rajiv Gulati, chair of the Division of Interventional Cardiology and Ischemic Heart Disease at Mayo Clinic and senior author of the study, said: ‘Our research highlights the larger need to rethink how we approach heart attacks in this patient population, and for younger adult women, in particular.‘Clinicians must sharpen their awareness of conditions like SCAD, embolism and stress-related triggers, and patients should advocate for answers when something doesn't feel right.’Their findings were published in the Journal of the American College of Cardiology. Heart attacks have traditionally been seen in older adults with a history of risk factors, such as obesity and high cholesterol.But today, one in five heart disease patients is under 40. Women are particularly likely to experience symptoms that seem incongruous to a heart attack, and thus go undetected. Despite being a healthy and active 28-year-old dancer, Eve Walker had no obvious risk factors for a heart attack Unknowingly living with a genetic heart condition, Walker's subtle symptoms, such as crippling exhaustion and a migrating pinch, escalated until she told a neighbor: 'I think I’m having a heart attack.' She was right. The diagnosis revealed hypertrophic cardiomyopathy, the same condition that had caused her sister’s unexplained deathAt just 28 years old, Eve Walker was an active, healthy modern dancer with no obvious reason to suspect she was at risk for a heart attack. Her underlying health appeared excellent. She was young, fit and had no known conditions. However, she was unaware she had a hidden genetic threat: hypertrophic cardiomyopathy, a condition that causes the heart muscle to thicken and can disrupt blood flow.Her symptoms were subtle and easily mistaken for other issues. They began with extreme exhaustion, such as becoming utterly winded while climbing stairs. Days later, she felt a strange, migrating 'mosquito bite type of pinch' that traveled up her leg and side to her face, accompanied by heavy legs and pain. This prompted her to tell a neighbor: 'I think I'm having a heart attack.' The hospital confirmed it. The event led to her diagnosis, revealing a severe familial heart condition that had tragically caused her sister's unexplained death years earlier. Moreover, experiencing a heart attack in one's 20s or early 30s is becoming more common by the year. From 2000 to 2016, the annual heart attack rate in the younger age group rose by two percent annually.
