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Heart attacks are usually linked to older people, but new findings from Northwestern Medicine, which came out this year in the Journal of the American Heart Association, indicate that the threat of heart problems might start to rise in people’s mid-30s. The study revealed that men in their mid-30s are almost twice as likely to experience heart disease in the next ten years compared to women of the same age. These results are attracting attention because they go against the old belief that heart disease mainly impacts those in their 50s or 60s. According to the World Health Organization (WHO), heart disease is still the top cause of death globally, claiming about 17.9 million lives yearly. However, many younger adults aren’t aware of the risk they face early on, as they often think heart issues are concerns for later in life. The new research indicates that the groundwork for heart disease can start much earlier, well before any symptoms show.

Heart disease doesn’t usually happen all at once. Rather, it often comes from slow changes happening in the body over many years. One of the key processes that lead to heart attacks is atherosclerosis, which involves the gathering of fatty substances, cholesterol, and inflammatory cells in the artery walls. Over time, these substances build up into plaques that make blood vessels narrower, limiting blood flow. As people get older, their blood vessels can become less flexible, and cholesterol levels might rise. Such changes can speed up the formation of plaques in the arteries that deliver blood to the heart. When a plaque breaks, it can lead to a blood clot that completely blocks the artery. This blockage of blood flow to the heart muscle results in a heart attack. Because this process is gradual, damage to the arteries can start many years or even decades before symptoms can be seen. This is why doctors are increasingly emphasizing the importance of prevention and monitoring risks early in adult life instead of waiting until middle age.

While heart disease has been linked mostly to older individuals, several recent lifestyle changes are raising the risk for younger adults. “The chance of having a heart attack can start much earlier than most people think, often from the mid-30s onward. Typically, heart disease is seen mainly in older adults, but changing lifestyles, stress, inactivity, and metabolic issues are now increasing the risk among younger people too. Some early signs, like high cholesterol levels, high blood pressure, obesity, and insulin resistance, can build up quietly during this time. So, people in their 30s should begin to focus on their heart health through regular health check-ups and by managing their lifestyles," explained Dr. Sunil Christopher, Consultant, Interventional Cardiology, SPARSH Hospital, RR Nagar, Bangalore. Long work hours, financial stress, and lack of sleep can raise stress hormone levels in the body, which may influence blood pressure, metabolism, and inflammation.

Smoking and too much drinking are also big factors in heart disease, especially for younger men. These problems together are leading to a troubling situation: more cases of heart attacks are being seen in adults under 40 in many areas around the globe. The Indian Heart Association reports that almost 25% of heart attacks in men happen before they turn 40. Some studies indicate that around 1 in 5 individuals with heart issues is 40 or younger. Johns Hopkins has observed a rise in heart attacks in women aged 35 to 54. This pattern indicates that heart problems are not just affecting older individuals anymore. Research from Northwestern Medicine points out a crucial difference in how men and women experience risk for heart disease. Men usually face a higher risk of heart disease earlier in life. By the time they reach about 35, concrete differences in risk between men and women start to show. Various biological and lifestyle factors might explain this trend.

The risks of heart disease for men and women differ mainly due to hormones and levels of HDL cholesterol. Women have estrogen, which helps protect their hearts and maintain healthy blood vessels. As a result, women often experience heart disease later than men, usually after menopause. Men lack this hormonal factor, which is why their risk for cardiovascular issues rises sooner, explained Dr. Vijay D’silva, Medical Director at White Lotus International Hospital and Clinical Advisor and Mentor at Heartnet India. He also mentioned that how fat is stored varies between genders. “Men often gain more visceral fat in the belly area, which is closely linked to inflammation, diabetes, and plaque buildup in arteries. Women, particularly before menopause, tend to store fat more in their hips and thighs, which is less harmful to metabolism. "

In addition, the way arterial diseases form is different. Men frequently have larger blockages in their heart arteries at a younger age. Women typically develop heart conditions later and sometimes in smaller blood vessels, he noted. However, doctors have observed that the difference between men and women is decreasing in some areas due to changing lifestyle habits. Although traditional risk factors like high blood pressure, high cholesterol, and smoking are still vital to heart disease, researchers are starting to focus on other biological factors that could affect risk. One of these is Lipoprotein(a), a type of cholesterol influenced largely by genetics. High levels of Lipoprotein(a) are linked to an increased risk of heart attacks and strokes and are relatively common in certain populations. Ongoing inflammation is another issue gaining more attention. Continuous inflammation in the body can lead to the formation and instability of plaque in the arteries.

Certain autoimmune disorders, which involve unusual functioning of the immune system, have been associated with an increased risk of heart disease. In women, complications during pregnancy, like preeclampsia or gestational diabetes, may indicate a higher chance of heart disease developing later in life. Researchers mention that these new risk signs are assisting doctors in creating better ways to identify individuals who could benefit from earlier treatments. "Besides common symptoms like chest pain or pressure, there are many early warning signs that people often miss. These can include unexplained tiredness, shortness of breath during everyday activities, palpitations, feeling dizzy, discomfort in the jaw, neck, or left arm, and excessive sweating. Some patients might also report discomfort similar to indigestion or slight chest tightness. Younger people, especially, often disregard these symptoms or blame them on stress or acidity. Recognizing these early warning signs and getting medical evaluation quickly can greatly lower the chance of a serious heart event," remarked Dr Anil Mishra, Director, Cardiology, BM Birla Heart Hospital, Kolkata.

Dr D’silva highlighted that environmental issues like pollution and initial metabolic changes, such as increasing LDL or blood sugar levels, can quietly elevate the risk of a heart attack long before any symptoms arise. Recent studies have raised concern that standard cardiovascular risk assessment tools may underestimate risk for younger people. These tools usually calculate the chance of having a heart attack or stroke in the next ten years. Since younger individuals typically have a lower short-term risk, early warning signs might not always cause medical worry. However, many experts now believe that lifelong risk should be given more focus. "Early screening is vital because heart disease can develop quietly over many years. By the time symptoms show up, the issue might be quite serious. With teleconsultations, young adults can easily talk about early risk factors with heart doctors. Continuous remote monitoring helps keep track of important health measures, while remote ECG gadgets enable heart rhythm checks from home. This provides doctors with a clearer understanding of heart health risks and allows for timely lifestyle adjustments and preventive treatments," emphasized Dr D’silva.

In numerous countries, especially in Europe and the US, clinical guidelines are increasingly recommending cardiovascular risk evaluations at a younger age, starting in the 20s and 30s. The good news is that heart disease can mostly be prevented, especially when steps are taken early on. "Preventing heart disease starts with building healthy lifestyle habits from a young age. Regular exercise, consuming a balanced diet full of fruits, vegetables, and whole grains, while limiting processed foods can greatly lower the risk. Steering clear of smoking, drinking alcohol in moderation, managing stress, and ensuring enough sleep are also crucial. Routine health check-ups monitor blood pressure, cholesterol, and blood sugar levels. Minor but steady lifestyle changes in younger years can significantly contribute to heart health and prevent early heart issues," stated Dr Mishra.

Dr D’silva suggested that regular medical examinations, continuous tracking of blood pressure, cholesterol, and blood sugar levels, along with healthier lifestyle choices can help recognize heart risks early and avert significant problems later.