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.
Why Fatal Heart Attacks Are Rising in Young Adults
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.
COVID's Link to Heart Disease and Heart Attack
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.
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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.
Why More Young Adults Are at Risk for Heart Disease
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.
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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.
How Young People Can Lower Their Heart Attack Risk
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.
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.
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