Major Cause of Heart Attacks in Younger Patients? Smoking

Smoking accounts for most heart attacks before age 40

young smoker
young smoker. antimoloko/Getty Images

Smoking is probably the most efficient way to ruin your health. Not only does smoking cause cardiovascular disease (things like myocardial infarctions, stroke, peripheral artery disease, abdominal aortic aneurysms and sudden death), but it also causes several types of cancer (most prominently lung cancer), chronic obstructive lung disease, peptic ulcer disease, osteoporosis, diabetes, and premature aging of the skin.

Worse, smoking often does not wait for us to hit late middle age before it begins to cause these serious problems. All too often, the results of smoking become manifest in young people, before they have a chance to enjoy their prime of life.

And it now appears that smoking is the most important cause of premature heart attacks.

Smoking and Premature Myocardial Infarctions

In a recent study of nearly 7000 patients who suffered an acute heart attack, nearly 80% of patients between 18 and 35 were smokers. In contrast, only about 23% of the general population in that age range are smokers.

Similarly, investigators from Finland also found that young smokers under age 40 have an impressively elevated chance of having a myocardial infarction than nonsmokers.

They reached this conclusion by examining data from the World Health Organization Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) database.

This massive study collected data on individuals from 21 countries in the 1980s and 1990s, including data on cardiac risk factors and subsequent cardiac "events.”

From this MONICA database investigators determined that, among younger patients (less than 40 years of age) who had suffered heart attacks, 80% were smokers.

And for smokers the risk of suffering a heart attack before age 40 was 4.9 times (men) and 5.3 times (women) higher than for non-smokers.

Even more strikingly, for over half of these young heart attack victims, smoking was the only cardiovascular risk factor that could be identified.

The Bottom Line

Smoking greatly accelerates atherosclerosis in anybody, at any age. Thus, even smokers who survive past 40 without overt cardiac disease are very likely to develop heart attacks or strokes years - or even decades - earlier than they otherwise might.

Not all smokers under 40 have heart attacks, of course, and not all smokers have heart attacks at any time. But if you smoke, your odds of developing cardiovascular disease are markedly higher than if you don’t smoke. Furthermore, your odds of developing premature cardiovascular disease (which, even if it does not kill you right away is likely to leave you disabled to some degree) are many times higher than they need to be.

Smoking is particularly likely to produce premature cardiovascular disease if you have a family history of heart disease, take birth control pills, or have other prominent risk factors such as diabetes, high cholesterol, hypertension, or obesity.

Not smoking is one of the best things we can do for our health, and the critical need to be a nonsmoker applies to us all, whatever our age.


Larsen GK, Seth M, Gurm HS. The ongoing importance of smoking as a powerful risk factor for ST-segment elevation myocardial infarction in young patients. JAMA Intern Med 2013; 173:1261.

Mahonen MS, McElduff P, Dobson AJ, et al. Current smoking and the risk of non-fatal myocardial infarction in the WHO MONICA Project populations. Tob Control 2004; 13:244-250.

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