Young Adult Heart Attacks on the Rise in the US

Ron Blankstein, MD A new study found that the rate of young US adults to have a heart attack has been growing—despite decreases in the overall number of heart attacks, increased patient use of medications like statins, and a decline in smoking.

The study, presented at the American College of Cardiology (ACC) 2019 Annual Scientific Sessions in New Orleans, LA, is the first to compare young (41-50 years old) to very young (40 or younger) heart attack survivors. Investigators found that the number of very young people having heart attacks has been increasing by 2% per 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,” senior author Ron Blankstein, MD, a preventive cardiologist at Brigham and Women’s Hospital and associate professor at Harvard Medical School, said in a statement.

The study, which observed 2097 patients treated at 2 large hospitals from 2000-2016, found that 1 in every 5 heart attack sufferers who experience a heart attack before 50 were 40 years or younger.

Despite being a decade younger on average than patients who suffered from a heart attack in their 40s, very young patients had the same rate of adverse outcomes. Investigators found that very young patients had the same rate adverse outcomes, including death from another heart attack.

“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 in a statement. “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 the study, investigators aimed to identify possible risk factors that could explain the increase in heart attacks among younger adults. They found that traditional risk factors for heart attacks including diabetes, high blood pressure, smoking, family history, and high cholesterol were similar between the 2 groups, but found that the youngest patients were more likely to report substance abuse.

Authors noted that 17.9% of the patients 40 or younger reported substance abuse, including use of cocaine and marijuana, compared to just 9.3% of the older group being examined.

Blankstein also reported a non-statistical trend toward less use of aspirin and statins upon discharge among very young patients. Yet, Blankstein felt this could suggest a bias in terms of clinicians believing these patients were at lower risk because of their age.

In a related study, that Blankstein is also presenting at ACC, investigators found that 1 in 5 patients who suffer a heart attack before 50 also had diabetes. Data showed that diabetics are more likely to die and have repeat events than heart attack survivors without diabetes.

These patients should be treated aggressively and clinicians should pay close attention to all other modifiable risk factors. Blankstein added that there are 2 classes of diabetes medications that have been shown in clinical trials to significantly reduce the likelihood of cardiovascular events within diabetics.

The studies, "Risk Factor Profiles and Outcomes of Very Young Adults with Myocardial Infarction: Results from the YOUNG-MI Registry," and "Diabetes is Associated with Worse Long‑Term Outcomes in Young Adults After Myocardial Infarction: The Partners YOUNG‑MI Registry," were presented at ACC 2019.

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