Even though fewer heart attacks are occurring in the US, these events are steadily rising in very young adults. New data reveal that more heart attacks are striking younger people, especially those with diabetes. Unfortunately, the proportion of very young people having a heart attack has been increasing, rising by 2 percent each year for the last 10 years.

As part of their analyses, Blankstein MD, a preventive cardiologist at Brigham and Women's Hospital, associate professor at Harvard Medical School in Boston and the study's senior author and colleagues tried to identify possible risk factors behind the increase in heart attacks among younger adults. They said that traditional risk factors for heart attack, including diabetes, high blood pressure, smoking, family history of premature heart attack and high cholesterol, were similar between the two groups. However, the youngest patients were more likely to report substance abuse, including marijuana and cocaine (17.9 percent vs. 9.3 percent, respectively), but had less alcohol use.

Researchers compared young heart attack victims (<50 years vs. ≤40) using patient angiograms, a procedure that uses X-rays to see the heart's blood vessels and arteries. People in the very young heart attack group were more likely to have the disease in only one vessel, suggesting that this disease was still early and confined, yet they had the same rate of bad outcomes. The very young group also had more spontaneous coronary artery dissection -- a tear in the vessel wall -- which, while rare, tends to be more common in women, especially during pregnancy.

"It all comes back to prevention," Blankstein said. "Many people think that a heart attack is destined to happen, but the vast majority could be prevented with earlier detection of the disease and aggressive lifestyle changes and management of other risk factors. My best advice is to avoid tobacco, get regular exercise, eat a heart-healthy diet, lose weight if you need to, manage your blood pressure and cholesterol, avoid diabetes if you can, and stay away from cocaine and marijuana because they're not necessarily good for your heart."

In a related study, Blankstein and his team found that 1 in 5 patients who suffer a heart attack at a young age overall -- defined as younger than 50 years of age -- also have diabetes. Data show that if someone has diabetes, they are more likely to die and have repeat events than heart attack survivors without diabetes. Not only is diabetes one of the strongest risk factors for having a heart attack, but it also predicts future events in young people who have previously had a heart attack. The good news, Blankstein said, is that there are now two classes of diabetes medications that have also been shown in clinical trials to significantly reduce the likelihood of cardiovascular events, including heart attack or stroke, or dying from one.

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