Too young to have a heart attack? think again

If you don’t already, it’s time to start taking your heart health seriously. That’s true even if you’re young and even if you’re in pretty good shape. Hidden conditions like high cholesterol and taking certain types of birth control can put even the most health-conscious young women at risk for heart disease.

It's time to set aside the tired myth that heart attacks happen mainly to older men. This dangerous assumption often leads women—and healthcare providers (HCPs)—to delay lifesaving treatment or to overlook heart attacks in women altogether. The reality is, heart attacks account for about one in five deaths among women in the United States and rates are higher among young women today than they were 20 years ago.

Learn about the unique health issues affecting young women and how to keep yourself—and the people you love—heart-healthy.

You’re not too young for a heart attack

Heart attack rates are on the rise among younger adults between 35 and 54 years old, according to a 2018 study published in the journal Circulation. Researchers examined more than 28,000 cases of people hospitalized for heart attacks from 1995 to 2014. The sharpest increase was seen among the younger women, who accounted for almost one-third of female heart attacks during this time period.

Compared with young men, women under 55 were also less likely to:

• Receive necessary diagnostic tests, such as a coronary angiogram
• Undergo lifesaving procedures, including surgery to restore blood flow to the heart
• Be prescribed appropriate medications, like beta-blockers

Young women who experienced heart attacks were also more likely to be black and to have other serious conditions like type 2 diabetes, compared to their male counterparts.

What’s driving this trend?

Young women may have received different care due to a host of factors, including widely held misconceptions about who’s likely to have heart attacks and a lack of awareness about heart attack warning signs in women.

While chest pain is the most common heart attack symptom across sexes, women are more likely than men to report:

• A different type of chest pain. (Men tend to describe their pain as “tightness,” while women often call it “sharpness” or “burning.”)
• Other symptoms instead of chest pain, including nausea, weakness or fatigue, and pain in the neck, jaw, throat, upper abdomen, or back

Some research suggests that “silent” heart attacks, which have vague or subtle symptoms that can be mistaken for heartburn, anxiety, overexertion, or another cause are also more common among women. In fact, nearly two-thirds of women who die suddenly of coronary heart disease have no previous symptoms, according to the Centers for Disease Control and Prevention (CDC).

“Women’s heart attack symptoms may be less typical,” says Hafeza Shaikh, DO, FACC, a cardiologist and internal medicine specialist in Cherry Hill, New Jersey. “This means they can take longer to get picked up on and there's a chance for heart disease to progress more before it’s diagnosed.”

“As a cardiologist—with my cardiology goggles on—I always want to investigate whether the cause is heart-related,” Dr. Shaikh explains. “I'd rather see a person 10 times for a false alarm than, God forbid, never getting to meet them because they didn’t realize what they were feeling was life-threatening.”

Heart attack risk factors in women

Diabetes and obesity, which are associated with poor diet and lack of exercise, are key heart attack risk factors for men and women. But Shaikh suggests that some women may be less aware of their “silent” or hidden risk factors for heart attack, such as high blood pressure, high LDL (aka “bad" cholesterol) and low HDL (“good” cholesterol).

“Sometimes women focus on body weight and size as risk factors because those are things you can physically see from the outside,” Shaikh says. “Unfortunately, we can't see our cholesterol or blood pressure, but they can start changing the arteries as early as our teen years.”

Aside from well-known risk factors for heart disease that affect everyone, such as poor diet, obesity, and inactivity, young women may experience additional, distinct risk factors, such as:

• Diabetes or high blood pressure during pregnancy
• History of spontaneous miscarriage or stillbirth
• Menopause starting at age 44 or earlier, or menstrual periods starting at age 10 or earlier
• Anemia, a condition in which low hemoglobin or low red blood cell levels make it difficult for oxygen to travel throughout your body. One possible cause of anemia can be excessive blood loss during menstrual periods. (But don’t just assume that’s the case—tell your HCP if you experience anemia symptoms so they can make a proper diagnosis.)
• Depression, which makes it difficult to get regular exercise and stick to other heart healthy habits, has been shown to disproportionately affect women’s hearts.

Some women also may experience higher blood pressure when taking hormonal birth control pills. Birth control methods containing the hormone estrogen with or without the hormone progesterone can promote blood clotting as well. This can contribute to heart attack and stroke. (Keep in mind that smoking while using hormonal birth control is a double whammy that can increase your heart disease risk by 20 percent.)

While most women can safely use hormonal methods, the American Heart Association recommends talking to your OBGYN, your primary care provider, and your heart specialist before starting any birth control regimen.

Women may also face certain social stressors, like higher rates of poverty, sex and/or race-based wage gaps, and competing pressures at work and home. These factors may contribute to heart attack risk and interfere with women’s likelihood of seeking preventive and emergency care.

Several unique factors increase heart disease risk among Black women as well. In fact, almost 50,000 Black women die from cardiovascular disease each year and nearly half of all Black women age 20 and older have some form of the condition. Despite this, only one in five black women believes she’s actually at risk. (Learn more about the issues affecting black women's heart health.)

Practice self-care

It’s essential for even young and middle-aged women to take steps to protect their heart health, and seek emergency care when they need it.

If you’re accustomed to putting others’ needs before your own, try recruiting loved ones, friends, and coworkers to help you prioritize your health. Some things you should consider:

Avoid sedentary social activities: Invite friends on hikes or other active outings, like the American Heart Association Heart Walk.

Address caregiver burnout: Women are more likely to be unpaid caregivers, and millennial women (in their late 20s to early 40s) are increasingly assuming this role. Caring for a sick or elderly relative can produce great mental and physical strain and make it difficult to care for yourself. Find caregiving resources to help balance your health with the needs of your loved one.

Set family goals: For example, you could make stress reduction a family priority. Attend group counseling sessions, commit to listening actively and kindly when family members voice emotion, and decompress after long days by taking calming walks together.

“If you can't take care of yourself first, you're not going to be able to help others in your life,” Shaikh points out. “It's absolutely easier said than done, but many women could benefit greatly from focusing more on self-care.”

Be proactive

Nearly 50 percent of all Americans have at least one of the three leading risk factors for heart disease (high blood pressure, high LDL, and smoking). Work with a cardiologist to track risk factors, such as your blood pressure, over time.

“People often don't want to see a doctor unless they're sick, but there’s value in that routine checkup,” Shaikh says. “If everybody could just prompt three to four family members to get evaluated, that would make a huge impact on the prevalence of heart disease.”

Starting at age 20, if your blood pressure is below 120/80, you should have it checked during your routine health visits or at least once every two years. If your blood pressure is higher than 120/80, talk to your HCP about how often you should be screened.

If you’re age 20 or older, you should also have a fasting lipoprotein profile once every four to six years. (This test looks at cholesterol levels and other important markers in your blood.) If you have heart disease or if you’re at higher risk, you may need to have your cholesterol checked more frequently. Talk to your HCP about which screening schedule is best for you.