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Study Identifies Hidden Causes of Heart Attacks in Younger Adults, Especially Women

Heart disease is often associated with older age and traditional risk factors such as high blood pressure or high cholesterol. But a new Mayo Clinic study shows that younger adults, especially women, may experience heart attacks that are driven by less common causes. These hidden causes often do not show up in standard tests and are not related to the build up of plaque in the arteries. The findings, published in the Journal of the American College of Cardiology, highlight these underrecognized causes can delay diagnosis and treatment, putting younger patients at greater risk. At Private Health Management (PHM), our researchers and clinicians stay current on the latest cardiovascular research and guide patients in choosing the strategies that will best support their heart health.

What the study found

Doctors at Mayo Clinic examined 15 years of data from over 2,700 patients under age 65 who had heart attacks. They found that many patients, especially women, did not have the “traditional” risk factors like diabetes or clogged arteries.1 Instead, their heart attacks were linked to lesser-known conditions, such as:

  • Spontaneous coronary artery dissection (SCAD): A tear in the wall of a heart artery.2
  • Coronary vasospasm: A sudden tightening of the arteries that reduces blood flow to the heart.3
  • Microvascular dysfunction: Problems in the tiny blood vessels that can’t always be seen on standard heart tests.4

In this younger group of patients, the findings showed that:

  • Plaque buildup in the arteries (atherosclerosis) remained the leading cause of heart attack overall, but it accounted for only 47% of cases in women compared with 75% in men.1
  • Heart attacks were less common in women than men, but when women did have heart attacks, the underlying causes were often misdiagnosed.
  • More than half of heart attacks in this group of women stemmed from these nontraditional causes, making them harder to accurately diagnose.

In younger patients, heart attacks were harder to recognize, and outcomes varied depending on the cause:

  • They often had fewer traditional risk factors such as high blood pressure, high cholesterol, or diabetes.
  • Many cases, particularly those caused by SCAD, were misdiagnosed as more typical plaque-related events, delaying the most effective care.
  • Recovery outcomes differed depending on the cause of the heart attack.
  • Patients with SCAD generally recovered well, while those whose heart attacks were linked to conditions like anemia or infection faced more serious health challenges.


Why the study matters

Heart disease is still the leading cause of death in the U.S., but younger adults often do not see themselves as being at risk.5 This study shows that even healthy, active people can be affected. These results highlight the importance of accurate diagnosis and tailored treatment strategies for younger patients. Young people should never dismiss symptoms like chest pain, shortness of breath, or sudden fatigue as “stress” or “just being tired.”

What young people can do to prevent heart disease

To protect their heart health, younger adults, especially women, are advised to:6,7

  • Pay attention to warning signs. If you have chest discomfort, unusual shortness of breath, or sudden fatigue, seek care right away.
  • Advocate for yourself. If tests are normal but symptoms continue, ask your doctor about SCAD, vasospasm, or microvascular disease.
  • Know your family history. Having a relative with heart disease can increase your risk, especially if the relative is a parent or sibling.
  • Build healthy habits now. Regular exercise, a balanced diet, stress management, and avoiding smoking can all lower risk.
  • Have regular wellness exams. An established relationship with a healthcare provider can help ensure regular heart-health screenings.
  • Manage your stress. Long-term stress causes an increase in heart rate and blood pressure that can damage the artery walls. Stress-management techniques can benefit your body and quality of life.

The bottom line

Heart attacks are not limited to older adults. Younger people—and particularly women—can be affected by hidden causes that require special attention. Listening to your body, seeking prompt care, and asking the right questions can make a life-saving difference.

References

  1. Raphael, C. E. et al. Causes of Myocardial Infarction in Younger Patients. JACC 86, 877–888 (2025).
  2. Hayes, S. N. et al. Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association. Circulation 137, e523–e557 (2018).
  3. Swarup, S., Patibandla, S. & Grossman, S. A. Coronary Artery Vasospasm. in StatPearls (StatPearls Publishing, Treasure Island (FL), 2025).
  4. Dankar, R., Wehbi, J., Atasi, M. M., Alam, S. & Refaat, M. M. Coronary microvascular dysfunction, arrythmias, and sudden cardiac death: A literature review. Am Heart J Plus 41, 100389 (2024).
  5. Heart disease remains leading cause of death as key health risk factors continue to rise. American Heart Association https://newsroom.heart.org/news/heart-disease-remains-leading-cause-of-death-as-key-health-risk-factors-continue-to-rise.
  6. Myocardial Infarction in Young Individuals: A Review Article | Cureus. https://www.cureus.com/articles/121711-myocardial-infarction-in-young-individuals-a-review-article#!/.
  7. How to Help Prevent Heart Disease At Any Age  www.heart.org https://www.heart.org/en/healthy-living/healthy-lifestyle/how-to-help-prevent-heart-disease-at-any-age.
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Tracy Arsenault

Tracy Arsenault, MS, PA-C

Managing Clinical Director | Physician Assistant

Tracy Arsenault is a Managing Clinical Director at Private Health Management, where she leads a clinical unit focused on clients with serious and complex medical conditions. Tracy supports clients with multiple medical conditions and is instrumental in developing and implementing complex treatment plans designed to achieve optimal outcomes. With more than 14 years of experience as a Physician Assistant, she has specialized in cardiology, cardiothoracic surgery, and vascular surgery. Her background includes extensive work as a Clinical Research Associate in endocrinology and nuclear medicine at prestigious institutions like Memorial Sloan Kettering and Brigham and Women’s Hospital. Tracy is a licensed Physician Assistant in California, certified by the National Commission on Certification of Physician Assistants, and holds dual Master degrees in Exercise Physiology and Physician Assistant Studies.