Heart Attack Risk in Young People

"Silent" Factors May Increase Odds Even in Athletes

man with chest pain

When you look at the statistics, it would be fair to assume that the risk of a heart attack in younger people is relatively low. In fact, of the 735,000 heart attacks reported in the U.S. each year, only around four percent occur in persons between the ages of 35 to 44.

While this may suggest you have nothing to worry about until you are well into your 50s or 60s, think again. While the overall risk may be low, a number of "silent" factors can raise the odds significantly even if you are in otherwise perfect health.

Facts About Heart Attacks

A heart attack, also known as a myocardial infarction, occurs when the blood supply to a section of the heart gets blocked. Without the quick restoration of the blood flow, that portion of the heart muscle will die. Heart attacks are most often the result of coronary artery disease (CAD) in which a waxy substance called plaque gradually accumulates on the artery walls.

According to a report from Centers for Disease Control and Prevention, heart disease is the leading cause of death in men between the ages of 45 to 54 as well as those over 65. The same applies to women over 65. Moreover, one in every four deaths in the U.S. is a direct result of heart disease. Of these, CAD accounts for roughly 610,000 deaths each year.

The risk factors for a heart attack include:

  • High blood pressure
  • High cholesterol
  • Smoking
  • Diabetes
  • Poor diet
  • Being overweight or obese
  • Inactive lifestyle
  • Excessive drinking

    Risk Factors in Younger People

    While it may seem reasonable to assume that heart attacks in younger people are a result of an unhealthy lifestyle (smoking, obesity, lack of exercise), it's not always the case.

    Oftentimes, a heart attack will strike the healthiest of individuals with little if any warning.

    We have seen this even among elite athletes like fitness guru Jim Fixx who died of a heart attack at 43 while jogging or ultra-marathon legend Micah True who died at 58 while on a casual run in the country.

    In both cases, the men didn't have any of the typical risk factors associated with heart disease. Rather, they had undiagnosed heart abnormalities that placed them at unusually high risk.

    It is not as uncommon an occurrence as one might think. Some studies, in fact, suggest that as many as one in every 500 high school athletes has a pre-existing heart condition that may be trivial in youth but contribute to heart disease risk later in life. Others may have more serious conditions that can lead to a heart attack in one's 20s or 30s.

    Among some of the more common causes:

    • Hypertrophic cardiomyopathy is an inherited condition characterized by enlarged heart muscle cells. This enlargement causes the walls of the ventricles to thicken, effectively blocking the blood supply. It is the most common cause of heart attack in young athletes.
    • Kawasaki disease, a rare childhood disorder, causes the acute inflammation of blood vessels. When it affects the coronary arteries, it can deprive the heart of oxygen-rich blood and lead to an abnormally rapid heart rate (tachycardia), cardiac inflammation, and heart failure.
    • Cardiac scarring can develop due to the long-term effects of excessive endurance exercise. Over time, the excessive stress can affect heart activity and trigger a cardiac event. The autopsy reports of Micah True revealed this to be his cause of death.

    Preventing Heart Attacks in Young People

    The prevention of heart disease in young people is the same as for older adults: better diet, regular exercise, weight control, routine check-ups, and smoking cessation.

    Beyond that, many health officials today are calling for the same standard of cardiac screening for high school athletes as is required by many NCAA colleges.

    This would include a review of the athlete's cardiac risk factors, blood pressure, heart-related symptoms, family history, and other in-office exams.

    The evaluation is meant to flag individuals in need of referrals to a cardiologist for further testing, including an electrocardiogram (ECG) or cardiac ultrasound.


    Centers for Disease Control and Prevention (CDC). "Heart Disease Facts." Atlanta, Georgia; updated August 24, 2017.

    Maron, B.; Friedman, A., Kligfield, P. et al. "Assessment of the 12-Lead ECG as a Screening Test for Detection of Cardiovascular Disease in Healthy General Populations of Young People (12-25 Years of Age)." Circulation. 2014; 130(15):1303-34. DOI: 10.1161/CIR:000000000000025.