You Can’t Put an Age on Heart Disease

“One out of every 10 heart attack victims aren’t even old enough to join AARP,” says Cooper Clinic Cardiologist Nina Radford, MD . “Think about it. These victims could be your brother or sister instead of your mother or father.”

So, why are heart attacks and strokes occurring at younger ages? Radford discusses the possible risk factors associated with such cases and what you can do to show your heart some love.

The average age at which a first heart attack occurs is 65 years in men and 72 years in women. With advances in medical treatments and improved awareness of symptoms of heart attack, there has been a significant reduction in the risk of dying from a heart attack over the last 20 or 30 years.  Unfortunately, this good news applies only to older adults.

One study examined changes in heart disease mortality rates between 1979-2011 across various age groups. Adults over the age of 65 showed a steady decrease in coronary heart disease mortality over this period, whereas adults under the age of 55 initially have seen little change in their risk of death from coronary heart disease.

Another study focusing on hospitalization rates for heart attacks from 2001-2010 showed a 20 percent decline in hospitalization rates for those over the age of 65, but no significant decline in hospitalization rates among younger women and men.

“Potential explanations for this important disparity might include a lack of awareness about whether they have risk factors for heart disease,” explains Radford. “It can also be due to poor control of cardiac risk factors once they are identified.”

According to the World Health Organization , a risk factor is any attribute, characteristic or exposure of an individual that increases the likelihood of developing a disease. According to the Centers for Disease Control and Prevention , about half of all Americans have at least one of these three most common risk factors for heart disease:

Just what does a heart attack victim’s risk factor profile look like at a younger age? A recent study examined the characteristics of more than 230,000 patients ages 30-54 who were hospitalized with a heart attack from 2001-2010. The results showed:

• 25 percent were women
• About 50 percent had high blood pressure (hypertension)
• About 1/3 of the women and 1/4 of the men had diabetes
• 12 percent of women and 14 percent of men had abnormal cholesterol

This relationship between increasing risk factor burden and increasing cardiovascular risk was demonstrated in a study in which a large group of men and women, initially free of cardiovascular disease, had their risk factors measured at age 45, 55, 65 and 75. Investigators monitored their health outcomes over these three decades.

In men age of 45 who had not yet been diagnosed with cardiovascular disease, the risk of developing it over the remainder of their lifetime was less than 5 percent with an optimal risk factor profile, about 40 percent with one risk factor and 50 percent with two or more risk factors.

In women, it was 5 percent with an optimal risk factor profile, about 20 percent with one risk factor and 30 percent with two or more risk factors.

An optimal risk factor profile is defined as:

• Total cholesterol level <180 mg/dL
• Blood pressure <120/80 mmHg
• Non-smoker
• Non-diabetic

You can’t pick your parents.  In general, coronary heart disease (CHD) at younger ages is strongly influenced by genetic factors. Almost half of younger patients with CHD have a family history of premature CHD (brother or father were diagnosed before age 55; sister or mother were diagnosed before age 65). The association between family history and premature CHD can be due to both genetic and environmental factors and at this point, genetic factors are hard to modify.

There are, however, many modifiable risk factors that play important roles in the development of coronary heart disease. The most common? Cigarette smoking.

Statistics show an estimated 15 percent of U.S. adults over the age of 18 smoke. The majority of those smokers started around age 14 or 15. Approximately 16 percent of students in grades 9-12 report smoking cigarettes.

Fewer young adults also report being screened for high cholesterol than older adults. A common approach is to wait until risk factors develop to prescribe lifestyle changes or pharmacological treatment, rather than prevent or delay the onset of risk factors.

“For the future, we should place greater emphasis on primordial prevention of risk factors in youth; this means preventing the development of risk factors in children and adolescents in the first place by improving their knowledge about healthy lifestyle choices and increasing their access to heart healthy nutrition and regular physical activity,” says Radford. “When these primordial efforts are not sufficient to prevent the development of obesity, hypertension or diabetes, then these conditions should be treated aggressively with lifestyle modification and medications if needed.”

For more information about Cooper Clinic, call 972.560.2667 or visit cooper-clinic.com .