A heart attack is a medical emergency that occurs when blood flow to a part of the heart muscle suddenly stops. This interruption prevents oxygen from reaching the heart, leading to damage or death of the affected tissue if not treated promptly.
Recent reports indicate a noticeable rise in heart attacks among younger adults, particularly those aged 35–55. But what are the underlying causes? Here’s a detailed overview.
Causes of Heart Attacks in Adults Under 65
The heart, like other organs, needs a continuous supply of blood and oxygen to function. When one of the arteries supplying the heart is blocked or impaired, a sudden heart attack can occur. According to heart surgeon Professor Ahmed Helmy Omar:
Direct causes include:
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Atrial fibrillation
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Coronary artery blockages
Indirect causes include conditions or lifestyle factors that increase risk:
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High blood pressure
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High cholesterol
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Long-term smoking
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Diabetes
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Cardiac rhythm disorders
A recent study by Mayo Clinic found that many heart attacks in people under 65—especially women—are caused by factors beyond the usual blocked arteries. This challenges traditional assumptions about heart attack mechanisms in younger adults.
New Findings on Heart Attacks
The study, published in the Journal of the American College of Cardiology, analyzed over 15 years of data from the Rochester Epidemiology Project. It provided a comprehensive assessment of heart attack causes in adults 65 or younger.
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Non-traditional factors accounted for more than half of heart attacks in women under 65, including spontaneous coronary artery dissection (SCAD), embolisms, and other non-atherosclerotic causes.
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While women experienced fewer heart attacks than men, the underlying causes in women were often misdiagnosed. SCAD, for example, was frequently overlooked or mistaken for typical plaque-related heart attacks.
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Traditional atherosclerotic coronary disease was still the most common cause overall but represented only 47% of heart attacks in women compared to 75% in men.
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Patients with heart attacks triggered by stressors such as anemia or infections had higher five-year mortality rates, despite having fewer cardiac injuries.
Previously Overlooked Causes
Spontaneous coronary artery dissection (SCAD) and other non-traditional triggers highlight the need for proper diagnosis. According to Dr. Claire Raphael, interventional cardiologist at Mayo Clinic and lead author of the study:
“Recognizing the root cause of a heart attack is as important as treating it. Misdiagnosis can lead to ineffective or even harmful treatments.”
For instance, treating SCAD with unnecessary stenting can increase complication risks, while accurate diagnosis allows for appropriate care and better long-term outcomes.
Key Study Findings
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Out of 1,474 heart attack cases studied, 68% were caused by traditional plaque buildup.
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Non-traditional causes accounted for most heart attacks in women.
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SCAD was six times more common in women than men.
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Heart attacks triggered by stressors (like anemia or infection) were the second most common cause overall and carried the highest five-year mortality (33%).
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Truly unexplained heart attacks were rare, accounting for less than 3% after specialist review.
Implications for Diagnosis and Treatment
The study emphasizes the need to rethink how heart attacks are diagnosed and managed in younger adults, especially women. Dr. Rajiv Gulati, senior author and chief of interventional cardiology, notes:
“Clinicians need to increase awareness of SCAD, embolism, and stress-related triggers. Patients should advocate for answers if something feels wrong.”
By understanding these non-traditional causes, healthcare providers can improve diagnosis, treatment, and long-term outcomes for younger adults at risk of heart attacks.
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