Why More Young Adults Are Dying From Heart Attacks and How to Reduce Your Risk

Heart attacks are often synonymous with older adults, and for good reason: In general, people 45 and older are more likely to have a heart attack than younger adults, according to the Mayo Clinic.

But heart attacks happen in young people, too. And, alarmingly, the number of young adults affected has been climbing in the past few years — especially since the start of the COVID-19 pandemic.

Here's how a cardiologist breaks down the causes of a heart attack at a young age, along with the possible link between COVID-19 and heart disease.

A wide variety of things can lead to a heart attack, but there are several standout risk factors that make someone more likely to have one.

According to the American Heart Association (AHA), typical risk factors for heart attack include: chronic conditions like high blood pressure, high cholesterol and diabetes; lifestyle factors like having overweight or being a smoker; and non-modifiable factors such as aging, sex (men are at higher risk) and having a family history of heart attack.

These haven't changed, but the risk of heart attack has shifted a bit with the prevalence of COVID-19, says Brianna Costello, MD, a cardiologist at The Texas Heart Institute Center for Cardiovascular Care.

During the first two years of the pandemic, there were 90,000 more deaths than expected for that period of time from heart-related issues, according to a February 2023 study in ‌Nature Cardiovascular Research‌.

The majority of these were in older adults, according to a September 2022 ‌Journal of Medical Virology‌ study, as might be expected. But that study also found that heart-related deaths increased significantly in younger adults, with the sharpest rise in deaths from heart attack occurring in people ages 25 to 44.

For one thing, COVID infection — at any age — is linked to an increased risk of heart problems and heart attack.

Indeed, a February 2022 ‌Nature Medicine‌ study says the risk of developing a heart condition after being infected with COVID-19 is strong, no matter how minor symptoms may have been and even if a person has no other risk factors for heart disease.

And a large November 2022 study in ‌eClinicalMedicine‌ found that unvaccinated people who had had COVID were at a significantly higher risk of developing a heart-related disease in the year after infection, including being nearly twice as likely to have a heart attack.

The reasons behind this aren't totally understood just yet, but we do know that a COVID-19 infection can cause inflammation in the heart that leads to arrhythmias and heart damage, according to Penn Medicine. These up your risk for heart attack and heart failure.

And the researchers behind the ‌Journal of Medical Virology‌ study believe COVID-19 may trigger or speed up pre-existing heart disease, even in young adults.

Inflammation is one likely culprit, but there also seems to be a link between COVID-19 infections and high blood pressure, which is a risk factor for heart attacks.

An August 2023 paper in the ‌Journal of Hypertension‌ found that more than 20 percent of people hospitalized with COVID and more than 10 percent of those with a milder case went on to develop high blood pressure in the months after infection.

What's more: Many people have missed appointments with their primary care doctors or cardiologists since the start of the pandemic, Dr. Costello says.

"Many of these patients already had a diagnosis of heart disease," she notes, and missing appointments may have caused them to fall behind on managing their condition and risk factors like high blood pressure and diabetes.

All of which leads us to our next point: Even before COVID-19, heart disease risk in young adults has been climbing for at least the past decade.

COVID-19 isn't the only thing to blame for young adults' risk for heart disease and heart attack. That risk has actually been on the rise since at least 2009 because of a steady increase in risk factors such as diabetes, obesity and high blood pressure in this age group, according to a March 2023 study in ‌JAMA.‌

Diabetes is a high risk factor for having an early heart attack, according to the Cardio Metabolic Institute (CMI). High blood sugar damages blood vessels, increasing the chance of fat clogging up your arteries.

People living with diabetes are also more likely to have other chronic health conditions that add more risk of a heart attack, including high blood pressure and high cholesterol.

High blood pressure, also known as hypertension, is another big risk factor for heart disease and heart attack, and it's rising faster in young adults than in older adults, according to CMI.

Finally, having overweight significantly increases the risk of having a heart attack, Dr. Costello says. Extra weight places more demand on your heart, making it harder to properly function. Having overweight can make anyone more likely to have a heart attack, even if they are otherwise healthy.

Heart attacks are no longer medical events that should only be considered when you get older. Yes, it's very possible to have a heart attack at a young age, especially with the threat of an infection like COVID-19 that affects heart health, Dr. Costello says.

On the bright side, many of the biggest risk factors — like hypertension, high cholesterol, a sedentary lifestyle and smoking — can be managed with certain lifestyle changes.

Dr. Costello recommends 150 minutes or more of exercise every week to decrease your risk for heart disease and stroke. This is also the official recommendation from the Department of Health and Human Services, per their Physical Activity Guidelines for Americans.

"Activity is crucial to maintaining heart health and can help control blood pressure and blood sugar," she says.

Some of the best exercises for heart health include:

• Running
• Dancing
  
• Walking
• Tennis
• Cycling

The nicotine in cigarettes and e-cigarettes is a toxic substance that increases the risk of heart attack, according to Johns Hopkins Medicine.

Smoking also raises your blood pressure, spikes adrenaline and increases your heart rate, all of which make a heart attack more likely.

The Mayo Clinic suggests these strategies to quit smoking:

• Nicotine replacement therapy
• Avoid triggers that make you crave smoking
• Chew gum
• Delay giving into temptation
• Go for a walk or jog when cravings hit
• Try relaxation techniques

A growing body of research — including a July 2022 research letter in ‌JAMA‌ and March 2023 study in the ‌Journal of the American College of Cardiology‌ — shows that people who have gotten the COVID vaccine are less likely to have a heart attack after being infected with COVID.

Researchers think this might be because the vaccine reduces the inflammatory effects of COVID and also reduces your risk of developing severe COVID.

It's true there's a small risk of myocarditis (inflammation of the heart muscle) after getting the mRNA COVID vaccines (those from Pfizer and Moderna), according to the Centers for Disease Control and Prevention (CDC).

However, the risk of myocarditis after being ‌infected‌ with COVID is much higher — up to 28 times higher for males 30 and older, per the CDC.

For that reason, the CDC says the best way to protect yourself against COVID-19 and associated heart complications is to get vaccinated.

Hereditary heart attack risk can't be changed, but the more you know, the more equipped you can be, Dr. Costello says.

Sharing family medical history with your doctor allows them to treat you appropriately and receive comprehensive care (especially when it comes to prevention).

Ask about your family members' health history so you're more prepared to manage your own.

Food has the potential to help or hurt us depending on the dietary choices we make. Maintain a heart-healthy diet that includes nutrient-dense, whole foods, per the Mayo Clinic. These include:

• Fruits and vegetables
• Beans or other legumes
• Lean meats and fish
• Low-fat or fat-free dairy foods
• Whole grains
• Healthy fats, like avocado and olive oil

Incorporating more of these foods in your everyday life as opposed to ultra-processed and less-nutritious foods will also help you maintain a healthy weight and help prevent chronic conditions like diabetes, high blood pressure and high cholesterol, per the Mayo Clinic.

Stress can be unavoidable, but the more you manage your stress levels, the happier your heart will be.

While certain levels of stress are normal, there is a link between chronic stress and heart problems, per the AHA.

Coping with stress can also get harder as you age, so take the time now to find stress-relieving strategies that work for you.

Simple and easily accessible stress relief methods include:

• Write out your feelings
• Take deep breaths
• Play upbeat music
• Spend time with pets

Heart health is more important than ever in the wake of the COVID-19 pandemic, and people of every age should take action to lower their risk for heart disease and heart attack, Dr. Costello says.

While some risk factors are outside our control, anyone can work toward lowering their risk by prioritizing a healthy lifestyle that aims to keep things like weight, blood sugar and blood pressure in check.

If you have a family history of heart attack, speak with your doctor to come up with a personalized prevention plan.