World Heart Day 2023: Why Are Young People More Likely To Die of a Heart Attack?

When you read headlines of seemingly fit and healthy 40-year-olds, 30-year-olds, and even 20-year-olds dying of heart attacks, does it make you gasp and wonder: How could this be?

In truth, what makes heart attacks in young people so newsworthy isn't so much that it is happening, but that heart attacks in this group are likely to be far more deadlier than in the elderly.

On this World Heart Day, FIT speaks to experts to decode the science of why younger people are more likely to die of a heart attack than older people.

Are Heart Attacks More Fatal in Younger People?

"Yes, absolutely," says Dr Sanjay Mittal, Senior Director, Clinical Cardiology and Research, at Medanta, Gurugram.

"There is no 100 percent or zero percent. It is not necessary that those who have a heart attack will succumb to it, but the chances of a young person having a larger injury due to blockage in their artery are much higher compared to an elderly person."

Dr Sanjay Mittal, Senior Director, Clinical Cardiology and Research, at Medanta, Gurugram

Let's get this straight, the incidence of deaths due to heart attacks is still higher among the elderly as the burden of heart disease is still largely among the elderly, asserts Dr Ajay Kaul, Chairman, Cardiac Sciences, Fortis Hospital, Noida.

However, he goes on to explain, "The problem is, more and more younger patients are having heart attacks. Say, a young patient has coronary artery disease at the age of 35-40; he is going to have a much worse outcome as compared to an elderly patient."

Why Does This Happen?

"This is so because, in a young person, the chances are that the blockage has happened suddenly," Dr Sanjay Mittal elaborates.

"Over time, calcium, minerals, and fats deposit in our arteries forming blockages known as plaque, and when these blockages restrict blood flow to the heart, they cause heart attacks."

Dr Mittal explains that in the elderly, these blockages "are built slowly over time, so the heart gets adjusted to those blockages."

He further explains that over time, the heart works around to this gradual build-up of plaque by forming natural bypasses – essentially allowing blood flow through alternate arteries to make up for the blocked ones.

"This, unfortunately, does not happen in the younger age group, and most of the time, this age group has sudden heart attacks because of clots forming in the other pipes."

Dr Sanjay Mittal, Senior Director, Clinical Cardiology and Research, at Medanta, Gurugram

"In case of these larger damages, the heart doesn't have time to cope by forming its natural bypasses," he adds.

"If the disease is so severe that it has got accelerated block build-up, these are the patients who get heart attacks," explains Dr Ajay Kaul.

On top of this, experts that FIT has spoken to for previous stories have also pointed out that plaque build-up in younger people is also more likely to be ignored till it becomes very severe.

"We used to misdiagnose these young MIs (acute myocardial infarctions) very frequently earlier because we would not suspect that the person is having a heart attack."

Dr Vishal Rastogi, Director, Interventional Cardiology, Fortis Escorts Heart Institute, New Delhi

There is also the fact that many early tells of heart damage in young people can be so elusive that the person may not connect it to the heart at all.

Warning Signs To Look Out for

• Diffused, dull chest pain

• Heaviness and pressure in the chest or upper stomach

• Pain or discomfort in the jaw

• Sudden sweating

• Shortness of breath or feeling of obstruction in the chest

• Retrosternal–behind the breast bone–burning that may be mistaken for acidity

• Pain in the arm

• Fatigue

All these can be signs of a heart attack.

This, however, doesn't mean that you need to rush to get an ECG every time you feel exhausted or sweaty.

Exhaustion may be a sign of a heart attack. "If a person feels excessively exhausted and says that he is feeling very weak in spite of there being no real reason for it," explains Dr Kaul.

Another telltale sign according to Dr Kaul is: "If you're having a symptom, it could be anything – chest pain, jaw pain, etc – if it is relieved on rest, and increases rapidly on exercise, this is a very very classical finding of heart problems."

If the pain is constant, persists, and doesn't get released when you sit or rest, "this is usually muscular pain and is not classical heart pain," he adds.

"If the patient has sharp, cutting pain, like somebody is stabbing him or like pinpricks, this is not cardiac pain. Cardiac pain means a peculiar squeezing, like somebody squeezing the chest, or heaviness. And the moment you walk, it increases."

Dr Ajay Kaul, Chairman, Cardiac Science, Fortis Hospital, Noida

In previous stories, FIT has spoken to experts and extensively covered the cause of heart attacks in young people.

To sum it up, it's a combination of poor lifestyle choices, erratic sleeping patterns, smoking, and lack of exercise, as well as some other factors that are outside your control like genetics, air pollution, and viruses.

And here's the stinger, Indians (South Asians) are genetically prone to a higher risk of not only having heart attacks but also having heart attacks years earlier than other races and ethnic groups.

According to the Indian Heart Association, approximately 60 percent of the world's heart disease burden is concentrated in India. Furthermore, heart attack tends to strike Indians almost 33 percent earlier than others.

Speaking to FIT, Dr Rastogi explained, "The data from India per se is limited but when they do population studies in Indians who have settled abroad in Singapore, America, or elsewhere in Europe, they find that Indians have a more severe disease at a younger age and suffer from heart diseases ten years earlier than their western counterparts."

One reason for this is, "people here are more prone to comorbidities of heart damage, like diabetes, hypertension," adds Dr Kaul.

Can You Reverse These Blockages?

The bad news is that currently, there is no way to melt away the blockages that have already formed.

But according to Dr Sanjay Mittal, it is possible to reverse plaque build-up by as much as 30 percent.

Dr Mukesh Goel, Cardiothoracic & Vascular Surgeon, Apollo Hospital, Delhi, agrees, saying, "Some anecdotal studies have shown that control of risk factors and adoption of healthy diet and lifestyle may actually cause regression of plaque, or at least may prevent its progression."

The experts we spoke to unanimously agreed that this would require some drastic lifestyle changes, like quitting smoking, exercising regularly, and cutting out all unhealthy, fatty foods from your diet.

This will first and foremost stop the progression of the plaque buildup and stabilises the existing plaque build-up.

"These blockages are developed slowly over time, and we are responsible for developing these. If we maintain a good balanced lifestyle from childhood onwards, very early on in life, you can actually prevent the formation of blockages."

Dr Sanjay Mittal, Senior Director, Clinical Cardiology and Research, at Medanta, Gurugram

(FIT has republished this story in light of World Heart Day, which is celebrated every year on 29 September to spread awareness about the prevention, management, and treatment of cardiovascular issues.)