Heart attacks are increasingly occurring among younger Americans, primarily because the conditions that increase the risk for heart attacks are appearing earlier in life.

The scene is one just about anyone would recognize: A middle-aged man suddenly grimaces, grabs the left side of his chest, and collapses. For bystanders, which can include family, friends or complete strangers, the decision is an easy one: call 911. And few of us would ignore the tell-tale symptom — the feeling of an elephant sitting on our chest — if it were happening to us.

But what about the somewhat lesser-known scenarios? A woman who is experiencing shortness of breath and pain in her stomach? A 30-something male who suddenly breaks out into a cold sweat and becomes nauseated? 

Those can be heart attacks, too. And delaying action can increase the damage the heart attack causes — and increase the risk of death.

February is National Heart Month in America — a month set aside by the U.S. Centers for Disease Control & Prevention, the American Heart Association and others as an awareness month to alert Americans to the dangers of heart disease. You may think you can recognize a heart attack — after all, a CDC survey of heart attack victims found that 92 percent recognized the tell-tale symptom of chest pain as a heart attack. But only about one in four, 27 percent, recognized the other symptoms that they were having as being a heart attack. 

A LEADING KILLER

The statistics are grim. In the time you’ve been reading this article, two people have had heart attacks somewhere in the United States. By the time you’ve read another three paragraphs, someone else will have had a heart attack. 

That’s because about every 43 seconds, on average, someone suffers a heart attack — 735,000 a year. Grimmer still? Every 52 seconds, someone in America dies of heart disease. It’s America’s leading killer, especially in men between the ages of 45 and 54, and it’s responsible for one in every four deaths each year.

Unfortunately, that’s not the end of the bad news. Heart attacks are no longer a symptom of being middle-aged. Not exclusively. While the average age of a first heart attack is 66 in men, they’re happening in people younger and younger — primarily because the underlying health conditions that cause so many of them are showing up in adults and even America’s youth at younger ages.

A heart attack is caused when circulation of blood to the heart is blocked. If the blockage is not rapidly opened, heart tissue will die from a lack of oxygen. That is known as a myocardial infarction, or a heart attack. 

Usually, though not always, a heart attack is caused by coronary heart disease, a narrowing of the coronary arteries that carry blood to the heart. Coronary heart disease is usually caused by at atherosclerosis — a buildup of fatty plaque on the artery walls. 

As blood flow is reduced to the heart due to narrowed arteries, chest pain — called angina — can occur, particularly during exercise or stress. While angina itself isn’t a heart attack, it is a sign of an impending heart attack if it doesn’t go away with rest or after taking nitroglycerin.

If the blocked artery supplies a small portion of the heart, the heart attack is often milder. But even mild heart attacks can result in permanent heart damage, heart failure later in life, an abnormal heart beat, and a higher risk of a second heart attack.

When a large area of the heart is affected, a massive heart attack occurs, which can result in cardiac arrest, rapid death and permanent heart damage.

THE MAJOR RISK FACTORS

Three primary risk factors for heart disease are high blood pressure, high blood cholesterol, and smoking.

There are other conditions that affect the risk for heart disease, too. Obesity, diabetes, physical inactivity and unhealthy eating patterns are chief among them. 

The CDC is warning that heart disease doesn’t just happen to older adults. It is happening to younger adults more and more often. High rates of obesity and high blood pressure among younger people between the ages of 35 and 64 are putting them at risk of heart disease earlier in life. In fact, the CDC says that half of all Americans have at least one of the top three risk factors for heart disease.

Millions of Americans have high blood pressure, including many who are in their 40s and 50s. Startlingly, the CDC estimates that about half of people with high blood pressure don’t have it under control. That’s a problem because uncontrolled high blood pressure is perhaps the single biggest risk factor for heart disease, as well as stroke and other ailments.

But blood pressure is not alone. High blood cholesterol greatly increases the risk for heart disease, too. What’s more, several of the other factors that increase the risk for heart disease — such as diabetes, obesity, smoking, eating unhealthy foods and lack of physical activity — also contribute to unhealthy cholesterol levels.

Meanwhile, there are more than 37 million Americans who smoke — and thousands of young people start smoking every day, slowing starting the process of damaging their blood vessels.

Nearly one in three Americans — including nearly one in six children ages two to 19 — are obese. And nearly one in 10 people in the U.S. has diabetes, which causes sugar build-up that can damage blood vessels and nerves that help control the heart muscle. The CDC estimates that only one in five adults meet the physical activity guidelines of getting 150 minutes a week (that’s 2.5 hours, or 30 minutes each week day) of moderate-intensity exercise. And only one in 10 adults get enough fruits and vegetables in their diets each day.

KNOW THE SIGNS

Because heart attacks are happening in Americans younger and younger, the American Council on Science & Health says it’s especially important to know the symptoms of a heart attack.

The problem? Many don’t. In a survey of heart attack victims, 92 percent of respondents recognized chest pain as a symptom of a heart attack, but only 27 percent were aware of all major symptoms and knew to call 911.

It’s true that chest pain or discomfort is a chief warning sign of heart attacks. But not all heart attacks behave the same, and some don’t include chest pain at all — especially in women. Other symptoms include upper body pain or discomfort in the arms, back, neck, jaw or upper stomach, as well as shortness of breath, nausea, lightheadedness or cold sweats. Further, about 20 percent of all heart attacks are “silent,” with few symptoms.

DON’T HOLD OFF

The most important thing to know? If you or someone you’re around are experiencing symptoms that could indicate a heart attack, don’t wait: call 911. That’s especially true for people with major risk factors — such as a diagnosed heart problem, high blood pressure or diabetes — but it’s advice that should be heeded by everyone.

Science has helped medicine advance tremendously in just the past three decades. Heart attacks aren’t necessarily a death sentence. Today, most people are surviving their heart attacks. Nearly three out of four men, and six out of 10 women, live at least one year after suffering a heart attack — and, of course, many of those who survive will live much longer than that.

But the key to survival is prompt intervention. The outcome of a heart attack depends on how much of the heart muscle dies. Once blood flow through an artery has been stopped, the tissue begins to die, and it continues to die until the artery can be reopened. Doctors say that significantly more heart muscle death occurs after five or six hours of blockage than occurs within two or three hours. After about 12 hours, damage caused by a heart attack is irreversible.

It goes without saying, of course, that you don’t have 12 hours to wait to summon health. Most cardiac arrests that occur during a heart attack are within the first few hours. And nearly half of those — 47 percent — occur before the person experiencing the heart attack reaches the hospital. Statistics have shown that only about six percent of people who experience cardiac arrest outside a hospital setting will survive — despite the best efforts of bystanders and paramedics who administer CPR.

So the symptoms bear repeating: chest pin or pressure, or just a strange feeling in the chest; sweating; shortness of breath; nausea or vomiting; pain, or pressure, in the back, neck, jaw or upper belly, or in the shoulders or arms; lightheadedness or sudden weakness; and a fast or irregular heartbeat.

TAKE CONTROL

The health statistics don’t lie: Most adults in Scott County are at risk of a heart attack. But it’s never too late to reverse — or, in the case of certain medical conditions, such as diabetes, at least control — the risk factors that often lead to heart disease. Here are four easy ways to take control of your health, as recommended by the CDC:

Don’t smoke. If you do smoke, it’s not too late to stop. It’s not just heart attacks you have to worry about if you’re a tobacco user. Smoking is the leading cause of preventable death in the United States.

Manage your conditions. If you have high blood pressure, high cholesterol or diabetes, work with your health care provider to manage those problems. Take any medicines that you have been prescribed and follow your doctor’s orders.

Eat well. This includes foods that are low in trans-fat, saturated fats, added sugar and sodium. Fill at least half your plate with vegetables and fruits. Replace salt with spices. 

Stay active. Get moving at least 150 minutes a week. It doesn’t have to be all at once; 30 minutes before or after work each day will do the trick. You can even break up the 30 minutes into 10-minute segments around your family’s schedule.

For more information on heart attacks and how to prevent them, visit cdc.gov/heartdisease.

This article is the February 2019 installment of Focus On: Health, presented on the second week of each month by Brennan's Foot & Ankle Care, Big South Fork Medical Center, Roark's Pharmacy and Danny's Drugs as part of the Independent Herald's "Focus On" series. A print version of this article can be found on page A3 of the February 14, 2019 edition of the Independent Herald.