Early risk factors for heart disease: What to know before 45

It is common to believe that heart disease is something only older adults should think about, but the truth is that heart conditions affect a wide range of ages. Recent reports, such as one from the National Heart, Blood, and Lung Institute, show that heart disease in people ages 20-44 is actually on the rise.

Many people in their 20s, 30s and 40s are surprised to learn that they already have risk factors for heart disease. From lifestyle to genetics, asking questions about your risk before 45 lets you take steps to protect your heart sooner. And that can lead to better overall health through every stage to come.

What increases your risk factors for heart disease?

Your personal risk for heart disease is made up of many different factors—some of which you can control and some that you can’t. Like any health condition, you’ll want to understand how these factors combine to affect your overall risk for heart disease so you can get the heart and vascular care you need.

If you’re younger than 45, talk with your primary care provider now about what could affect your risk for heart disease today and in the future. Some common heart disease risk factors that you can control or treat include:

1. High blood pressure: You may have high blood pressure and not know it. That’s why routine blood pressure checks are important. Over time, high blood pressure can cause damage to blood vessels throughout your body and eventually lead to heart and vascular disease.
2. High cholesterol: High cholesterol is another heart disease risk factor that doesn’t usually cause symptoms, but it can be detected by a routine blood test. In younger people, very high cholesterol may be a sign of a genetic condition.
3. Smoking: No matter your age, smoking is the leading preventable cause of heart disease. Even if you’ve smoked from a young age, it’s not too late to improve your heart health. People who stop smoking see their risk of heart disease go down by 50% after three to six years.
4. Diabetes: People with both Type 1 and Type 2 diabetes have a higher risk of heart disease due to damage in the blood vessels from high glucose levels. And those with diabetes are more likely to develop heart disease early.
5. Obesity: Obesity is often linked to an increase in other risk factors for heart disease, such as high blood pressure. Some studies have suggested that people who have obesity early in life could develop changes to heart health at a young age.
6. Less-active lifestyle: A sedentary lifestyle—one with little to no daily physical activity—is a risk factor for heart disease. In younger people, increases in time spent on computers or smartphones instead of physical activity may be contributing to heart risks.
7. Poor dietary habits: Minimizing trans fat or saturated fat, ultra-processed food, processed meats, food high in salt or added sugars, and tropical oils (coconut, palm and palm kernel) can reduce the risk of stroke and heart disease.

Why heart disease is no longer just for older adults

So why is the rate of heart disease in younger adults going up? There are many different factors at play, from lifestyle shifts to a general lack of awareness among young people that they even have risk factors.

Medical professionals have also noted an increase in other conditions related to heart disease in younger groups, including obesity and diabetes. For example, from 2002 to 2018, the number of young adults diagnosed with Type 2 diabetes per year doubled.

Surprising risk factors for heart disease in people under 45

Controlling common risk factors like high blood pressure, high cholesterol, smoking, diabetes and obesity is essential to reducing the risk of heart disease at any age. But there are some less-commonly known factors people under 45 might want to discuss with their care team, too.

• Stress and mental health: Ongoing stress or untreated mental health conditions like depression often lead to lifestyle choices that can contribute to heart disease. When your body is under high levels of stress for a long time, it can also cause negative changes in your heart rate, blood flow, inflammation levels and more.
• Genetic conditions: Genetics can play a large role in your chance of developing risk factors for heart disease, such as high cholesterol. While you may have never heard of familial hypercholesterolemia, this genetic condition causes high LDL cholesterol levels and an increased risk of heart attacks at a young age.
• COVID-19: In the years after the COVID-19 pandemic, doctors noticed an increase in heart attacks in younger people. Additional studies found a link between heart rhythm problems, inflammation of the heart and other heart diseases with COVID-19 infection. This connection is still being studied.
• Poor sleep: From sleep disorders like sleep apnea to not getting enough sleep, there’s a known connection between sleep and your heart. Poor sleep can affect numerous risk factors for heart disease, including high blood pressure and obesity.
• Social isolation: While more research is needed, some studies have found a link between loneliness with the risk of heart disease. Societal shifts in relationships and the way people connect could be having an effect on heart health.

The early warning signs you shouldn’t ignore

Along with knowing your heart disease risk factors, get to know the warning signs that mean your heart could use some attention. As with any health condition, the sooner you catch signs of heart disease and take steps to address it, the more options you have to keep your heart healthy.

Signs that you shouldn’t ignore include:

• Chest pain
• Shortness of breath with exercise
• Ongoing fatigue or lack of energy, especially with exertion
• Changes in your heartbeat, such as fast heartbeats, frequent flutters or skipped beats
• Swelling in your legs and feet
• Dizziness or feeling lightheaded

Lowering your risk of heart disease

If you find out you’re at risk for heart disease, the best time to do something about it is now. Especially if you’re younger, any changes that you make today could have a significant impact on your heart health in later decades of your life.

Talk to your doctor about lifestyle changes and treatments such as:

• Following a heart-healthy diet 
• Quitting smoking
• Creating an exercise routine that works for you
• Taking medications to manage medical conditions related to heart disease
• Finding ways to manage stress
• Addressing conditions that affect healthy sleep

Keep your heart healthy year after year

One of the best things you can do for your heart through every decade of life is to partner with a healthcare team that helps keep you on track. If you have factors that put you at risk for heart disease, start the conversation with your doctor at your next checkup or find a heart specialist who can guide you through preventive steps to protect your heart now and moving forward.