Heart : Heart Disease Appearing in Younger Adults

By Paul Swiech, The Pantagraph, Bloomington, Ill.

The face of heart disease used to be your father. Now it's your adult children.

"It's not an old man's disease anymore," said Dr. Siddharth Gandhi, an interventional cardiologist at Advocate BroMenn Medical Center.

"Heart disease affects men and women and now, unfortunately, at younger ages," Gandhi said.

A generation ago, heart disease affected mostly men in their 50s and 60s. Now, it's affecting more women and men in their 20s and 30s.

"In the past three to four years, I've done interventions for people as young as 28," Gandhi said. Heart disease in young adults "has become a significant concern," he said.

One reason is because of growing obesity in young adults.

"That provides the fertilizer for developing diabetes, high blood pressure and high cholesterol," he said. Those diseases -- along with smoking -- greatly increase the risk of developing heart disease, he said.

"These processes used to affect people in their 60s but now it's affecting people at a younger age," he said.

Adding to the danger is that most young adults don't realize they're at risk of a heart attack.

Nine out of 10 Americans ages 18 to 24 believe they're living healthy lifestyles but most of them eat too much fast food, drink too much alcohol and sugary beverages and engage in other risky behaviors, according to a 2011 American Heart Association/American Stroke Association survey.

The disconnect means that most young adults do little to nothing to improve their health.

"They think they're invincible," Gandhi said.

What sometimes happens is that fatty substances, cholesterol and other products build up in the inner lining of an artery. That buildup -- plaque -- results in arteriosclerosis, a thickening of arteries.

When the plaque blocks blood flow through an artery, a heart attack may occur. A heart attack happens when blood flow that brings oxygen to the heart is cut off or severely reduced. When the heart is starved for oxygen and nutrients, the heart begins to die.

Sometimes, however, a heart attack isn't because of a poor lifestyle.

One example is a spontaneous coronary artery dissection, which is a tearing in the coronary artery wall.

The artery wall has three layers. When a tear occurs, blood passes through the innermost layer and becomes trapped, bulging inward and narrowing or blocking the artery. Because blood can't reach the heart, a heart attack occurs.

Spontaneous coronary artery dissection (SCAD) is rare. Patients are frequently otherwise healthy women who are pregnant, just had a baby or are peri-menopausal, Gandhi said.

"Because these events occur during an estrogen surge, we believe there is a hormonal link," he said. The release of estrogen may cause the artery to tear, "but why is still a mystery," Gandhi said.

Because SCAD happens in otherwise healthy younger women and has no warning signs until a heart attack, it underscores the importance of being treated as soon as you experience heart attack symptoms, he said.

Anyone who experiences pressure or tightness in the center of the chest and down the left arm -- sometimes accompanied by nausea, vomiting, shortness of breath, sweating and dizziness -- may be having a heart attack, he said.

If these symptoms occur at rest and last more than five minutes, call 911.

If they occur with exercise and then go away, see your doctor.

"When people in their 20s, 30s and 40s come in, they are scared to death," Gandhi said. "They thought this could only happen to elderly males. It was something their grandfather had when he was in his 60s."

The good news is that doctors may be able to reopen the artery with a balloon and a stent or surgeons may bypass the clogged artery. The sooner treatment happens, the sooner blood flow can be restored, minimizing damage to the heart, Gandhi said.

"When we can open their arteries quickly, this leads to better outcomes and patient survival," he said.

Gandhi recommends that everyone -- especially people with a family history of heart disease -- reduce their risk of a heart attack by monitoring and managing their blood pressure, cholesterol and blood sugar; not smoking; eating a heart-healthy diet that includes fresh fruits and vegetables; controlling weight and stress; and getting at least 150 minutes of moderate to vigorous exercise each week.

The tips also apply to people who want to reduce the odds of a second heart attack.

"When patients develop a healthier, more active lifestyle, that helps," Gandhi said. "Heart disease is not a death sentence."

©2013 The Pantagraph (Bloomington, Ill.)

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