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Young people are more likely to die of heart attacks post-COVID, study finds. But why?

A recent study found that heart attacks in people ages 25 to 44 increased by 30% compared to the expected number over the first two years of the COVID-19 pandemic.
/ Source: TODAY

When Demi Washington, a basketball player at Vanderbilt University came down with COVID-19 in late 2020, her symptoms were mild, just a runny nose. But to ensure her safe return to the court, the school required her to undergo an MRI.

The results brought Washington to tears.

Following the infection, the now college graduate had developed myocarditis — when the heart muscle becomes inflamed, which can decrease the heart's ability to pump blood. The condition can lead to stroke or heart attack, according to Mayo Clinic. Washington was not vaccinated against COVID-19 at the time.

"I was scared because any internal organ, you’re like, 'Oh, my gosh, I need that to live,'" she recalled to TODAY. "I didn’t really know what was going to come of it, how long was it going to take for it to resolve."

Demi Washington has recovered from her myocarditis and has returned to playing basketball. Many other young people who developed heart problems after a COVID-19 infection aren't so lucky.
Demi Washington has recovered from her myocarditis and has returned to playing basketball. Many other young people who developed heart problems after a COVID-19 infection aren't so lucky.Courtesy Demi Washington

Washington had to skip the rest of the 2020 to 2021 season, but ultimately she was grateful. "I think about the fact that Vanderbilt does do the MRI and a lot of other schools didn’t," she told TODAY in a segment aired Feb. 9. "The fact that I could have played if we didn’t is hard and scary to think about."

Washington's doctor never told her that she was at risk of dying, but he did stress the importance of rest and keeping her heart rate under a certain pace. She had to wear a watch to track her activity. Even though COVID was especially new at the time, Washington said her doctor felt confident her condition was due to the coronavirus, as he'd seen something similar other college athletes.

Washington said she felt no symptoms or signs that her heart had become inflamed, nor did she have a genetic predisposition. "It (just) happened to be me," she said. "I still don't really know why."

Washington has since recovered and is back to playing ball. But her experience sheds light on the thousands of young adults infected with COVID-19 whose health hasn't rebounded as successfully.

COVID-19, heart attacks and young people

Since the COVID-19 pandemic began, heart attack deaths across all age groups have become more common in the U.S., according to a September 2022 study by Cedars Sinai hospital in Los Angeles.

The age group hit the hardest? People between 25 and 44, who saw a 29.9% relative increase in heart attack deaths over the first two years of the pandemic (which means the actual number of heart attack deaths were almost 30% higher than the predicted number).

“Young people are obviously not really supposed to die of heart attack. They’re not really supposed to have heart attacks at all,” Dr. Susan Cheng, a cardiologist at Cedars Sinai and co-author of the study, told TODAY in a segment aired Feb. 9.

Adults between 45 and 64 saw a 19.6% relative increase in heart attack deaths, and those 65 and older saw a 13.7% relative increase, according to a press release from Cedars Sinai. The increase in U.S. heart attack deaths continued through the omicron surge, even though the variant is thought to cause milder illness, and spikes of heart attack deaths have aligned with the timing of COVID-19 surges in the U.S.

Los Angeles County paramedic Romeo Robles told TODAY in the Feb. 9 segment that upticks in COVID-19 would often lead to more 911 calls related to heart issues in his community.

"Surprisingly, people my age ... we would find them in cardiac arrest, and it was all predicted by these waves," he said.

Cheng called the connection "more than coincidental, that is for sure." Explaining why, she pointed out that COVID-19 can greatly impact the cardiovascular system.

"It appears to be able to increase the stickiness of the blood and increase ... the likelihood of blood clot formation," Cheng said. "It seems to stir up inflammation in the blood vessels. It seems to also cause in some people an overwhelming stress — whether it’s related directly to the infection or situations around the infection — that can also cause a spike in blood pressure."

The reason for the relative rise in young people in particular is unclear, but one theory, Cheng said, is that the virus's impact on the cardiovascular system in some people may be due to an excessive immune system response and that young people are more likely to have stronger immune systems.

COVID-19 and heart disease

For COVID-19 survivors, the risk of developing a heart condition even a year after infection, regardless of how severe symptoms were, is "substantial," according to a February 2022 study of more than 150,000 individuals with COVID-19. The risk increases even for people who don't have any other risk factors for heart disease.

Dr. Ziyad Al-Aly, a physician-scientist at Washington University School of Medicine in St. Louis and co-author of the study, estimated that about 4% of people who have COVID-19 will develop a heart problem, such as irregular heartbeat, heart failure, inflammation or heart attacks.

"It’s a small number, but really, it’s not (if) you multiply that number by the huge number of people in the United States and throughout the world who had COVID-19," he told TODAY.

One theory why this happens ties into how the body is supposed to respond to viruses — by creating inflammation, according to the National Heart, Lung and Blood Institute. "In some people with COVID-19, however, the inflammation seems to go into overdrive," the institute noted. "Too much inflammation may further damage the heart or disrupt the electrical signals that help it to beat properly, which can reduce its pumping ability or lead to abnormal heart rhythms ... or make an existing arrhythmia worse."

Some research is beginning to chip away at how COVID-19 impacts the heart. A February 2023 study found the inflammatory immune response to a COVID-19 infection can cause calcium to leak from the heart, potentially leading to a fatal, irregular heartbeat. The subjects in this study weren't vaccinated, and research shows a COVID-19 infection is more likely to cause heart problems than vaccination, according to the Centers for Disease Control and Prevention.

The National Heart, Lung and Blood Institute also points out that COVID-19 may affect the heart's cells. A January 2023 study, which began before the vaccine was available, looked at the relationship between a COVID infection and the protein troponin in the blood, which is associated with heart muscle injury or heart attack. It found that 61% of people hospitalized with COVID-19 who had high troponin levels had heart abnormalities, such a scarring from a heart attack.

Some people develop blood clots after a COVID-19 infection, sometimes in the heart, the National Heart, Lung and Blood Institute explains. The virus can attack blood vessels, causing a surge inflammatory cells, which can trigger the release of molecules that contribute to blood clotting, previously reported.

What's more, the risk of developing long COVID, including heart problems, increases with each COVID-19 infection an individual has, Al-Aly pointed out. As a result, Latino and Black communities, which have higher rates of reinfection, are especially high risk for heart problems post-COVID, Cheng said.

As doctors and other researchers continue to wade through the data on COVID-19 and heart disease, the best course of action is to avoid infection as best you can, Cheng and Al-Aly said. To do so:

  • Wear a mask in crowded settings, and consider socializing outdoors with people outside your household.
  • Stay up to date on your vaccinations. Research shows that you're 11 times more likely to develop myocarditis from COVID itself versus the vaccine, NBC News senior medical correspondent Dr. John Torres said during a TODAY segment on Feb. 9.
  • Take a COVID-19 test as soon as you start to develop any symptoms and stay home when you're sick.

If you've been infected with COVID-19, especially multiple times, Cheng also encouraged staying on top of your risk factors for heart disease, such as your blood pressure, cholesterol and blood sugar. Typical signs of heart attack, per the U.S. Centers for Disease Control and Prevention, include:

  • Chest pain or discomfort, such as pressure, squeezing or fullness.
  • Weakness, light-headedness or fainting.
  • A cold sweat.
  • Pain or discomfort in the jaw, neck or back.
  • Shortness of breath, either at the same time as or before chest discomfort.

Prior to the COVID-19 pandemic, heart attack deaths were trending downward in the United States, but the pandemic appears to have reversed the progress, according to the Cedars Sinai research.

"I'd love to say we're ... coming out on the other side and we can think of COVID more so like the common cold. Unfortunately, that is not the case. ... That is eminently clear from all of the data," Cheng said. "This is not even just like the flu. ... This virus is still very different from any other virus we have seen in our lifetime."