Study finds hidden causes of heart attacks often overlooked, especially in younger women

A Mayo Clinic study published in the Journal of the American College of Cardiology finds that many heart attacks in younger patients, particularly women under 65, are triggered by nontraditional factors beyond plaque buildup.

Researchers analyzed more than 15 years of data on 1,474 heart attack cases and found that while atherosclerosis remains the leading cause overall, its share differs by sex and age. The study reported that atherosclerosis accounted for about 75% of men’s heart attacks but 47% of women’s, with the gap widening among patients under 65.

In people under 65, especially women, nontraditional factors were more common. The researchers found that more than half of heart attacks in women under 65 were triggered by factors other than plaque buildup, including embolisms and spontaneous coronary artery dissection, or SCAD, which the team noted is nearly six times more common in women than men.

SCAD is often misdiagnosed as a typical heart attack caused by atherosclerosis, which can lead to treatments such as stenting that may not address the underlying cause. The study emphasizes the need to rethink how heart attacks are diagnosed and treated in younger patients, particularly women.

The analysis also linked some heart-attack cases to stressors such as anemia or infection. Patients whose heart attacks were driven by these nontraditional triggers had higher five-year mortality rates than those with more typical plaque-related events, the authors reported.

Raphael said recognizing and correctly diagnosing these nontraditional heart attacks allows for more appropriate care and better long-term outcomes.

Gulati added that it is crucial to recognize that not all heart attacks are identical or caused by the same events. Clinicians must sharpen their awareness of conditions like SCAD, embolism and stress-related triggers, and patients should advocate for answers when something doesn’t feel right.

Serwer cautioned that the study has limitations, including a lack of ethnic diversity and not accounting for the severity of underlying conditions. He noted that not all heart attacks fit a single pattern and emphasized the importance of listening to one’s body and seeking prompt care for new chest pain.

The most effective advocate is a well-informed patient, Serwer said. In new-onset chest pain, shortness of breath or severe exertional fatigue, medical attention should be sought immediately, the doctors said.

The researchers said the findings should prompt clinicians to consider nontraditional causes when evaluating younger patients with potential cardiac symptoms, and patients to discuss their risk factors and history with their providers.