Why do some young men have heart attacks—and what does this tell us about heart disease in middle age and beyond? The November 2009 issue of Harvard Men’s Health Watch answers this question and more.

As many as 10% of all heart attacks in men occur before age 45. As with heart attacks in older adults, about 80% of these attacks stem from coronary artery disease—that is, cholesterol-filled blockages in the arteries that serve the heart. Other causes of early heart attacks in men include abnormalities of one or more arteries, blood clots that form elsewhere and are carried to the coronary arteries, disorders of the clotting system, spasm or inflammation of the arteries, chest trauma, and drug abuse.

The lion’s share of coronary artery disease in younger men is associated with the same risk factors as in older folks. These include a family history of cardiovascular disease, smoking, high cholesterol, hypertension (high blood pressure), abdominal obesity, diabetes, metabolic syndrome, lack of exercise, hostility, elevated levels of C-reactive protein, and low educational attainment.

The Coronary Artery Risk Development in Young Adults (CARDIA) study put some of these risks into perspective. The researchers evaluated over 5,000 young adults ages 18 to 30, then monitored them for up to 15 years to find out how their risk factors influenced their heart health. Smoking 10 cigarettes a day increased the likelihood of coronary artery disease by 50%; every 30 mg/dL rise in LDL cholesterol increased risk by 50%; and every 10 mm Hg rise in systolic blood pressure increased risk by 30%.

Harvard Men’s Health Watch reminds men that they should not ignore heart attack warning symptoms just because they are “too young” to have heart disease, and that prevention should start early.

Read the full-length article: "Premature heart disease"