Mayo Clinic study finds hidden causes of heart attacks are common, especially in younger women
Researchers say nontraditional factors account for many heart attacks in women under 65, prompting a rethink of diagnosis and treatment
A Mayo Clinic study analyzing more than 1,474 heart attacks over more than 15 years found that nontraditional causes are common, particularly among women under 65. While atherosclerosis remains the leading cause of heart attacks overall, it accounted for 75% of men’s events but only 47% of women’s, according to the new analysis. In women under 65, nontraditional factors such as embolisms and spontaneous coronary artery dissection, or SCAD, were implicated in more than half of heart attacks.
SCAD is a tear in the coronary artery that can trigger a heart attack and is nearly six times more common in women than men. It is often misdiagnosed as a typical plaque-related heart attack, the researchers said, a misdiagnosis that can lead to unnecessary procedures such as stents. The study also found that heart attacks triggered by stressors like anemia or infection were linked to higher five-year mortality than those driven by more typical processes.
In a press release accompanying the Journal of the American College of Cardiology report, Claire Raphael, M.B.B.S., Ph.D., an interventional cardiologist at Mayo Clinic and the study’s first author, said recognizing and correctly diagnosing nontraditional heart attacks enables more appropriate care and better long-term outcomes. Senior author Rajiv Gulati, M.D., Ph.D., chair of the Division of Interventional Cardiology and Ischemic Heart Disease at Mayo Clinic, noted that the findings reinforce the need to rethink how heart attacks are approached, particularly in younger women.
Dr. Bradley Serwer, a Maryland-based cardiologist and chief medical officer at VitalSolution who was not involved in the study, said the results underscore that not all heart attacks are identical or caused by the same events. He stressed that while atherosclerosis remains a common cause, clinicians should stay alert for SCAD, embolism and other nontraditional triggers. Serwer also cautioned that the study has limitations, including a lack of ethnic diversity and the fact that it did not account for the severity of the underlying conditions.
Clinicians are urged to sharpen their awareness of nontraditional causes and to listen to patients who feel something is wrong, the researchers said. Understanding the root cause of a heart attack is crucial because it can influence treatment choices and long-term survival. The report emphasizes that there is no one-size-fits-all approach to treating heart attacks in younger patients and that patient history and careful assessment of symptoms are essential.
People experiencing new chest pain, shortness of breath or severe fatigue during exertion should seek immediate medical attention, even if they consider themselves low risk, the authors advised. Early recognition and tailored care can affect outcomes, they noted.
While the study advances understanding of heart-attack causes, the authors emphasized that more work is needed to improve diagnosis across diverse populations and to translate these findings into routine emergency care. The research, published in the Journal of the American College of Cardiology, analyzed data from more than a decade and a half and reviewed 1,474 heart attacks.
