Shawn Sherlock was a healthy 44-year-old mom who ate right and ran regularly. But on a January morning in 2017 as Sherlock was making breakfast for her two boys, her jaw started to ache and then an excruciating pain shot down her left arm.
“I thought, this could not be a heart attack,” Sherlock remembers. “I am too young and healthy.”
But something told Sherlock she’d better take this seriously. “I thought, I don’t want my boys to see me drop dead in front of them,” the Boca Raton, Florida, businesswoman told NBC News.
When her husband saw her, he knew something was very wrong and rushed her to the hospital. “Within a few hours I was in surgery and getting two stents to save my life,” she said.
That morning Sherlock joined the growing number of young women having heart attacks in the U.S.
Heart attacks are on the rise in young people, especially women.
While deaths due to heart disease had been decreasing steadily, those improvements plateaued recently and researchers may now know at least part of the reason why: Heart attacks are on the rise in younger people, especially women.
Between 1995 and 1999, 27 percent of those hospitalized for heart attacks were between the ages of 35 and 54, a new study found. Between 2010 and 2014 that number had climbed to 32 percent, with heart attacks in women showing the greatest increase, rising from 21 to 31 percent, according to a study published Tuesday in Circulation (and early online in November).
During the same time period, heart attacks also rose in younger men, but not as quite as dramatically: In men between 35 and 54, heart attacks climbed from 30 percent to 33 percent. While the percentage of heart attacks occurring in young men went up during the 20 years covered by the study, the actual number of heart attack in men in this age group went down. Young women did not see a similar decline, the researchers reported.
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“The greater percentage of heart attacks among younger patients is alarming,” said study co-author Melissa Caughey, an instructor at the University of North Carolina School of Medicine in Chapel Hill. “And that’s especially true in light of the fact that the population is aging.”
The damage sustained in a heart attack can lead to heart failure and other issues later in life, Caughey explained.
Women are less likely to receive the right medication.
Caughey and her colleagues explored heart attack trends using data from the Atherosclerosis Risk in Communities (ARIC) Study, which has been tracking hospitalizations for heart attacks in four geographically defined regions of the U.S. (Forsyth County, North Carolina; Washington County, Maryland; Jackson, Mississippi; and eight suburbs of Minneapolis, Minnesota).
Along with the dramatic increase in heart attacks in young women, the researchers also found that these hospitalized women were less likely than their male counterparts to receive guideline-recommended medications such as non-aspirin blood thinners (17 percent lower), cholesterol- lowering drugs (13 percent lower) and beta-blockers (4 percent lower). They were also 21 percent less likely than men to receive therapies to open clogged arteries.
“This is a very important study,” said Dr. Erin Michos, an associate professor of medicine and epidemiology and associate director of the Ciccarone Center for the Prevention of Cardiovascular Disease at Johns Hopkins University School of Medicine in Maryland. “The main message to women is you shouldn’t think you’re too young for a heart attack. There has always been a misconception that this is just a man’s disease. And that leads to women being underdiagnosed and undertreated.”
Younger women may not be getting screened for heart disease risk factors.
Another issue, Michos said, is that many women and doctors believe that there is less risk of a heart attack before menopause. And because of that, many younger women are not getting screened for heart disease risk factors, she said.
“In this study, more than 90 percent had modifiable risk factors, such as smoking, diabetes, high cholesterol and hypertension,” Michos said.
Part of the problem may lie in doctors’ perceptions of women, said Dr. Elizabeth Piccione, an assistant professor of medicine at the University of Pittsburgh Medical Center and a cardiologist with the UPMC Magee-Womens Heart Program.
For example, if a woman comes in and has high blood pressure she’s often told it’s because she’s anxious, Piccione said. When a man comes in with the same numbers, he’s told his blood pressure is high, she added.
“The number one thing that is going to kill and disable women is cardiovascular disease,” Piccione said. “One of the things we can take away from this study is that we are not aggressively treating women when we identify cardiovascular risk factors,” she added.
Preeclampsia could increase a woman's risk of heart failure or disease.
One risk factor that many women and doctors don’t know about involves pregnancy, Michos said. She points to a study showing that preeclampsia was associated a four-fold increased risk of future heart failure and a two-fold increased risk of heart disease, stroke and cardiovascular death. Preeclampsia is a complication that strikes some women after 20 weeks of pregnancy. Its symptoms include high blood pressure and signs of damage to the liver and/or kidneys. Untreated, it can be fatal.
That study highlights the importance of keeping a close eye on women who had preeclampsia during pregnancy for signs that heart disease may be developing, Michos said.
Those results might help explain Sherlock’s heart attack at age 44. During her first pregnancy she developed preeclampsia, which progressed to full eclampsia, complete with seizures and the beginnings of organ failure.
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Preeclampsia may give doctors a chance to identify women who are at high risk for heart disease, said Dr. Jennifer Haythe, an assistant professor of medicine at the Columbia University Medical Center-NewYork-Presbyterian Hospital and co-director of the Columbia Women’s Heart Center.
“Pregnancy is like a test for the heart,” Haythe explained. “When preeclampsia comes on in pregnancy it’s a sign that this person’s body couldn’t manage the added blood pressure and volume.”
Moving more could help women lower their risk.
Another important, modifiable risk factor may be the amount of time women spend sitting, experts said. A study published in the same issue of Circulation found that older women who spent fewer hours sitting or who frequently got up and walked around before sitting back down had a significantly lower risk of heart disease.
That study followed 5,638 women aged 63 to 97 who had no history of heart attack or stroke. At the beginning of the study the women wore a device called an accelerometer for a week. The device kept track of when the women sat or reclined and when they got up.
At the end of the study, nearly five years later, the researchers determined that for each additional hour the women spent not sitting, there was a 12 percent lower risk of any type of cardiovascular disease and a 26 percent lower risk of heart disease.
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“The difference between the top and lower 25 percent (in duration of sitting) as a 1.54 times higher risk,” said the study’s lead author, John Bellettiere, a postdoctoral research fellow at the University of California, San Diego.
Bellettiere and his colleagues suspect that longer unbroken hours of sitting impact cholesterol, blood pressure and blood sugar. They are currently studying how these risk factors are impacted by “bringing postmenopausal women into the lab three or four times over three or four weeks,” he said. “One day they will sit the entire time, another they will get up every 20 to 30 minutes.”
The sitting study shows how valuable small changes in behavior can be when it comes to heart disease Haythe said.
“What I stress to my patients is to ignore our society of extremes,” she said. “You don’t have to go from 300 pounds to 110 and be the ‘biggest loser.’ You can just try a walking program. And eat more of a Mediterranean diet. Over time those little changes can have a really big effect.”
