Eric Goulder, MD, FACC
Heart Talk - March 2019
Why Are Heart Attacks and Strokes on the Rise in Young Adults?
Heart-healthy and Stroke-free Living with Eric A. Goulder, MD, FACC
After Luke Perry’s death from a massive stroke at age 52, many people asked how this could have happened. Wasn’t the “Beverly Hills, 90210” star too young for a stroke? And could this tragedy have been prevented? Perry joins a growing list of celebrities who have fallen victim to heart attacks or strokes before age 55, including Sharon Stone, Rosie O’Donnell, John Mellencamp and Bob Harper.
Rates of cardiovascular events are soaring in younger adults, particularly among women. In a study of more than 28,000 people hospitalized for heart attacks between 1995 and 2014, a whopping 30% (8,737 patients) were between the ages of 35 and 54. Another recent study found that between 2003 and 2012, stroke rates rose by 43% among 45- to 54-year-olds, and by 36% in the 18-to-34 age group. What’s behind this alarming trend? Here’s a look at how to protect your arterial health at every age with the BaleDoneen Method.
ARE YOU AT RISK FOR A HEART ATTACK OR STROKE?
In a new study of more than 1.4 million young adults who were hospitalized for a heart attack, 92% had at least one of the following modifiable risk factors: high blood pressure, smoking, obesity, diabetes and high cholesterol. The research was published in Journal of the American College of Cardiology (JACC) in February.
Having even one of these risk factors also magnifies the threat of having a stroke at an early age, according to a study of stroke survivors ages 49 and under presented at the American Stroke Association’s International Stroke Conference in February. People in their 30s or 40s with at least two of these risks were ten times more likely to suffer a stroke than those with none.
The findings suggest that medical providers need to do a better job of screening younger patients for stroke risk, said Dr. Sharon Poisson, the study’s lead author. “People in their 20s and 30s aren’t typically thinking that high blood pressure or diabetes are things they need to worry about, yet they really do make an impact on stroke risk,” she told USNews.com.
WHEN SHOULD YOU START SCREENING FOR CARDIOVASCULAR DISEASE?
Yet many young people don’t know they are at risk until a heart attack or stroke occurs. In a 2015 study of young heart attack survivors ages 18 to 55, almost all of them had at least one of the risk factors listed above. Yet only 53% knew they were at risk before the event, and even fewer had ever discussed their risks or how to reduce them with their medical provider.
The study of young heart attack survivors also found that women were 11% less likely to be informed of their cardiac danger and 16% less likely to be counseled on risk factor modification, such as lifestyle changes, than men of the same age. An accompanying editorial stated that, “the rising epidemic of [cardiovascular disease] in younger women may be attributable in part to a lack of risk assessment and preventive therapy.”
As we recently reported, part of the problem is that most patients — and some medical providers — don’t know the right age to start screening for cardiovascular disease (CVD), the leading killer of men and women. In a recent national survey, 92% of patients thought, on average, that screening should start at age 41. Actually, the American Heart Association recommends that screening for cardiac risk start at age 20.
THE BEST TESTS TO SCREEN FOR HIDDEN CARDIOVASCULAR DANGER
CVD, which claims more American lives each year than all forms of cancer combined, can start to develop when people are in their teens or early 20s. If undetected and untreated, it can silently progress until it becomes severe enough to cause a heart attack or stroke.
Since heart attacks and strokes can occur in seemingly healthy people with few — or none — of the traditional risk factors, the BaleDoneen Method uses laboratory and imaging tests to directly check each patient for signs of hidden arterial disease.
Here are some of the best ways for young people to find out if they are at risk for a heart attack or stroke:
• BLOOD PRESSURE. Nearly 50% of Americans have elevated blood pressure, the leading risk factor for stroke, according to new guidelines from the American Heart Association.
• CHOLESTEROL. Most patients assume that the standard cholesterol test checks for all forms of dangerous cholesterol that raise heart attack and stroke risk. Actually, most healthcare providers don’t test for a common inherited cholesterol disorder: elevated levels of lipoprotein (a), a blood fat that triples risk for heart attacks. This disorder, which can be detected with a $20 blood test, turned out to be the culprit in celebrity fitness trainer Bob Harper’s near-fatal heart attack at age 51.
• BLOOD SUGAR. It’s very common for people to be diagnosed with diabetes or insulin resistance (IR, a pre-diabetic condition) shortly after they have a heart attack. While these disorders may sound unrelated, IR is the root cause of about 70% of heart attacks. BaleDoneen and other studies show that the most accurate screening test for IR is the two-hour oral glucose tolerance test.
• WAIST MEASUREMENT. A waistline measuring more than 35 inches for a woman or more than 40 inches for a man is one of the leading indicators of metabolic syndrome (a dangerous cluster of risk factors that triples risk for heart attack and quintuples it for type 2 diabetes).
• CAROTID INTIMA THICKNESS (CIMT). This 15-minute, FDA-approved test uses ultrasound to measure the lining of the largest artery of your neck — and can also detect arterial plaque (disease). In a recent study of 3.067 “healthy” adults under age 45 who were tracked for 16 years, cIMT measurements were shown to strongly predict risk for heart attack and stroke, independent of the person’s risk factors.
• ORAL HEALTH. A landmark BaleDoneen study was the first to identify bacteria from periodontal (gum) disease as a contributing cause of CVD. That means your dental provider is a potentially lifesaving member of your heart attack and stroke prevention team. To find out if you have high-risk oral bacteria, the BaleDoneen Method recommends using available tests from companies that measure oral pathogens through DNA analysis, including OralDNA, OraVital and Hain Diagnostics. About 50% of Americans ages 30 and older have gum disease, which has been linked to increased risk for CVD, Alzheimer’s disease, and several forms of cancer.
• GENETIC TESTING. As discussed more fully in the BaleDoneen book, Beat the Heart Attack Gene, about 50% of Americans carry genetic variants that greatly increase their risk for heart attacks and strokes at an early age. For more than a decade, the BaleDoneen Method has used a genetically guided precision-medicine approach, which has been shown in two recent peer-reviewed studies to effectively prevent, detect, treat and even reverse arterial disease, even in those with genetic risk.
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