The heart of the matter: The truth about heart health


In this article:

  • Women are just as much at risk for a heart attack as men — but they sometimes have different symptoms.

  • Heart disease can occur from cholesterol building up in the arteries over many years.

  • Know the signs of heart disease, and see your doctor if you have any doubts about your health.

If you’re in your 20s and 30s, you might think you don’t have to worry about heart disease yet.

But 5% of adults over age 20 may have coronary artery disease — including those who are younger than 40. A recent National Institutes of Health study found that more and more young adults are experiencing heart disease. In particular, people with a body mass index, or BMI, higher than 30 face a greater risk of heart disease.

Why you might be at risk for heart disease

A family history of heart disease is one of the biggest risk factors that increases your chances of a heart attack. But heart disease also can occur from cholesterol buildup over the course of decades. As that cholesterol piles up, the heart and arteries make up for the reduced blood flow — but only for a while.

That blockage eventually causes problems with the arteries, which is why untreated heart disease can lead to heart attack or stroke.

Heart attack is the nation’s No. 1 killer. It’s responsible for one in every five deaths. Around 800,000 people in the U.S. have a heart attack annually, and 600,000 of those were first-time heart attacks. These first-timers may not have even known they were suffering from heart disease, according to Cynthia Warner, M.D., a cardiologist at Providence Medical Group – North Everett Cardiology in Everett, Washington. Unfortunately, almost 700,000 Americans die from the disease annually.

“You want to catch and prevent heart disease before it becomes more significant,” Dr. Warner says.

Your risk factors and how you can manage them

Heart disease isn’t just when the “plumbing is blocked up,” says John Waggoner III, M.D., a cardiologist at Providence Cardiology Associates – Olympia in Olympia, Washington. About 20% of heart disease in young people results from abnormalities and defects, connective tissue disorders or autoimmune diseases.

“It’s normal to have some predisposition based on family history and genetics, but you’ll want to either delay or, more optimally, control risk factors by controlling what you can,” Dr. Warner says.

If you’re a young person with a genetic history of heart disease, high blood pressure, cholesterol, diabetes or tobacco use, you can work with your doctor to evaluate and reduce those risks, Dr. Waggoner says.

“It’s never too late to stop smoking and reduce your heart attack risk,” Dr. Warner says. “After just one year of quitting, you cut in half your risk of forming heart disease.”

You can also reduce your heart disease risk factors by lowering your stress level and losing weight. The American Heart Association recommends eating well using a whole-food plan like the Mediterranean diet. This diet features olive oil and other healthy fats, grains, legumes, fruits and vegetables.

Additionally, heart health depends on regular, moderate exercise (such as walking) five times a week for 30-45 minutes daily, Dr. Waggoner says.

Signs of heart disease 

The symptoms and signs of heart disease and heart attack are usually mild at first, and then they become more noticeable. “The symptoms don’t respect age groups,” Dr. Warner says — but can still be unique to you.

Traditional symptoms include chest pain, which is your clue that you have poor blood flow to the heart, pressure or shortness of breath with activities or exercise. But heart disease can start with more unusual symptoms, too, particularly for older people, people with diabetes, and women. It can lead to leg swelling and pain, an uneven heartbeat and shortness of breath.

Additional symptoms include:

  • Pain or discomfort that spreads to the shoulder, arm, back, neck, jaw, teeth or sometimes the upper belly.
  • Cold sweat.
  • Fatigue.
  • Heartburn or indigestion.
  • Lightheadedness or sudden dizziness.
  • Nausea.

Decades ago, people assumed women didn’t get heart disease. In reality, women just have different symptoms, Dr. Waggoner says. In the emergency department, a woman with chest pain might have been treated as if she were simply suffering from heartburn or muscle pain. As a result, her caregivers missed the signs until it was too late.

After a concerted effort, more people in the medical community and broader public now understand that women’s heart attack signs may differ from men’s. The American Heart Association’s Go Red for Women campaign raised awareness that women may have more unusual symptoms — fatigue, weakness, and referred or displaced pain — but that cardiovascular disease is the No. 1 killer of women.

One good example of an unusual sign is a woman who had a toothache that only emerged when she climbed up stairs. Soon, her doctors realized she had a severe blockage in an artery on her heart’s front wall — which “referred” pain to her lower jaw.

When many patients avoided visiting a doctor during the COVID-19 pandemic’s worst days, they often showed up weeks after a mild heart attack’s symptoms. That delay had repercussions. “When people finally did come in, the heart disease was much more severe than it would have been in previous years,” Dr. Waggoner says. 

The take-home message is clear: Know the signs of a heart attack, and seek treatment from your Providence doctor if you have any indication something might be wrong.

Contributing caregivers

Cynthia Warner, M.D., is a cardiologist at Providence Medical Group – North Everett Cardiology in Everett, Washington.

John Waggoner III, M.D., is a cardiologist at Providence Cardiology Associates – Olympia in Olympia, Washington.

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Related resources

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This information is not intended as a substitute for professional medical care. Always follow your health care professional’s instructions.

About the Author

The Providence Heart & Vascular Team is committed to bringing you many years of expertise and experience to help you understand how to prevent, treat and recover from cardiovascular diseases and conditions. From tips to eating better to exercise and everything in between, our clinical experts know how to help you help your heart.

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