Why young, slim people still get heart attacks

Young and slim isn’t a free pass

Heart attacks are not only a disease of older, overweight people. The INTERHEART study, which compared heart attack patients across 52 countries, found that the same handful of risk factors explains most heart attacks in every region and at every age. When those risk factors build up early, heart attacks come early.

Ancestry changes the picture too. In INTERHEART, people in South Asia had their first heart attack at a median age of 53, compared with 58 elsewhere, mostly because of higher levels of common risk factors at younger ages. People of South and East Asian descent also tend to develop diabetes and heart risk at lower body weights, which is why the WHO recommends a lower BMI cut-off for them: 23 or above already signals higher risk, compared with 25 for many other populations.

Slim isn’t the same as healthy

You can look slim and still have high blood sugar, high cholesterol, high blood pressure, or visceral fat around your organs. The American Heart Association describes this pattern in South Asians, but it can happen to anyone: more abdominal fat, more insulin resistance and more diabetes at a given body weight. Your heart responds to what’s in your blood vessels, not to how you look.

The risk factors that matter most

INTERHEART found that a small set of factors accounted for most heart attack risk:

• Abnormal cholesterol (lipids)
• Smoking, including other tobacco use
• High blood pressure
• Diabetes
• Abdominal obesity
• Psychosocial stress
• Low intake of fruit and vegetables
• Lack of regular physical activity

Every one of these can be measured, and most can be changed.

Warning signs — don’t wait

Chest pain, pressure or tightness; pain spreading to the arm, jaw, neck or back; breathlessness; cold sweat; nausea; or sudden unusual tiredness can all be signs of a heart attack. Women are more likely to have symptoms other than chest pain. If you think it could be a heart attack, call your local emergency number immediately — such as 112 across Europe and in many other countries, 911 in the US and Canada, or 999 in the UK. Don’t wait to see if it passes, and don’t drive yourself.

In men, new erectile difficulty can be an early sign of blood vessel disease. A meta-analysis found it is linked to higher cardiovascular risk, so it’s worth mentioning to a doctor.

Know your numbers

Get a baseline in your 20s:

• Blood pressure, measured with a cuff
• Fasting blood sugar or HbA1c
• A lipid profile (cholesterol)
• Waist size

Repeat them as your doctor advises. Knowing these numbers, together with not smoking and staying active, are among the most useful things you can do for your heart in your 20s and 30s.

References

1. 1.Risk factors for early myocardial infarction in South Asians compared with individuals in other countries (INTERHEART). JAMA, 2007.doi:10.1001/jama.297.3.286
2. 2.Atherosclerotic cardiovascular disease in South Asians in the United States: AHA scientific statement. Circulation, 2018.doi:10.1161/CIR.0000000000000580
3. 3.Appropriate body-mass index for Asian populations (WHO expert consultation). The Lancet, 2004.doi:10.1016/S0140-6736(03)15268-3
4. 4.Erectile dysfunction and cardiovascular disease: systematic review and meta-analysis. European Urology, 2014.doi:10.1016/j.eururo.2013.08.023

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Educational information, not medical advice. See a doctor for anything persistent or severe. All content is original to Venva.