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Why Are Heart Attacks Striking Younger People?

Most people in their thirties and forties don’t worry about having a heart attack, especially if they are fit and healthy, but heart attacks among adults younger than 50 years of age are on the rise, according to researchers at Brigham Health.

Results from their study were presented at the American College of Cardiology meeting and showed that among individuals who suffer a heart attack at a young age, 1 in 5 were 40 or younger and that number has risen 2 percent each year for the past decade.

In a related study published in a recent issue of Journal of the American College of Cardiology, these Brigham investigators showed that patients who suffered a heart attack before 50 may have a genetic disorder that results in high cholesterol, known as familial hypercholesterolemia (FH).

In fact, about 10 percent of patients who suffer a heart attack before 50 had FH, and many continued having high cholesterol levels a year after their first heart attack.

Familial Hypercholesterolemia

Approximately 1 in 250 people have familial hypercholesterolemia. The genetic condition contributes to high levels of low density lipoprotein, or the "bad" LDL cholesterol, typically above 190 mg. Since individuals with FH have high cholesterol from a young age, they’re usually at a higher risk for problems associated with high cholesterol (e.g., atherosclerosis).

“Many of the participants in our study with FH were not on a statin therapy before their first heart attack, highlighting opportunities for prevention and more aggressive treatment for those at risk,” says corresponding author of the paper Ron Blankstein, MD, a preventative cardiology specialist and associate director of the Cardiovascular Imaging Program at Brigham Health.

Only about half of the FH patients in the study were on a statin therapy before their first heart attack, and many were not treated aggressively following their event. One of the challenges of FH is that it’s under-recognized and under-treated (10 percent of all FH cases are diagnosed).

Intervening to lower cholesterol could help prevent not only subsequent heart attacks but also first heart attacks. “It’s important for both providers and patients to be aware of the real benefit associated with reducing cholesterol. It’s important to do so after a heart attack, but even before. If a patient has risk factors, there’s an opportunity to avoid heart attacks through aggressive cholesterol-lowering therapy,” says Dr. Blankstein.

Lower your risk of a heart attack by knowing your health numbers

While you can’t change risk factors such as age, gender, race and family history, you can modify the behaviors and conditions that increase your risk for cardiovascular disease.

By paying attention to the following health measures, you can take steps to prevent a heart attack.

  • Cholesterol: There are several measures of cholesterol, and all are important in determining cardiovascular risk. Your high density lipoprotein (HDL, or good) cholesterol should be greater than 50 mg/dl; low density lipoprotein (LDL, or bad) cholesterol should be less than 100 mg/dl; and triglycerides should be less than 150 mg/dl. (Take the Cholesterol Quiz). Achieving a lower LDL cholesterol is beneficial for patients who have an elevated risk of high cholesterol, or have coronary heart disease.
  • Blood pressure: Your blood pressure should ideally be about 120 (systolic) over 80 (diastolic) mm Hg, or lower. You should have your blood pressure checked at least once a year. Those who have already been diagnosed with high blood pressure should check their blood pressure more frequently.
  • Body Mass Index: Body Mass Index, or BMI, is a measure of the relationship between your height and weight. If your weight is too much for your height, you may have excess body fat, which can cause high blood pressure, heart disease and stroke. Your BMI should be between 18.5 and 24.0.

Making healthy lifestyle choices

You can also lower your risk of a heart attack by paying attention to certain lifestyle factors.

  • Nutrition: Make sure to choose foods that are low in saturated and trans fats, sugar, and salt. Try to eat a variety of vegetables and fruits and whole-grain or high fiber foods, while minimizing processed foods. Limiting red meat consumption and eating fish twice a week also can also lower your risk. A wide body of research has linked the Mediterranean diet or a plant-based diet to a reduced risk of heart disease.
  • Exercise: You can lower your risk of heart disease by getting regular, moderate-to-intense exercise. Try to be active for at least 30 minutes on most or all days of the week. Start small and then build more physical activity into your regimen.
  • Don’t smoke and drink moderately: If you smoke, quit. Smoking is the most preventable cause of death in the United States and one of the largest contributors to heart disease. If you drink alcohol, don’t drink heavily.

The Prevention of Heart and Vascular Disease Program

The Prevention of Heart and Vascular Disease Program at Brigham Health’s Heart & Vascular Center is a world leader in treating high cholesterol and other risk factors that contribute to the development of heart and vascular disease. To make an appointment, please request an appointment online or call (857) 307-4000.

- July 3, 2019