More Younger People are Getting Heart Disease

Healthy Aging

Why are heart disease trends heading in the wrong direction?

In support of American Heart Month, we are covering the latest in heart health science, including population trends, dietary saturated fats, LDL-cholesterol levels, and (of course) the role of C15:0 in supporting heart health.

This week, let’s talk about the downright disturbing rise in heart diseases, especially among younger people.

The concern around heart disease is an oldie but a baddie.

The leading cause of deaths globally is heart disease. It was heart disease in the 1950s. It is still heart disease today. In fact, heart disease has been the leading cause of deaths in the U.S. since 1921.

The most common type of heart disease is coronary heart disease, which affects about 20.5 million U.S. adults. As explained by the National Institutes of Health, coronary heart disease (also called ischemic heart disease) is when the arteries of the heart cannot deliver enough oxygen-rich blood to the heart.

Wait. I thought that heart disease numbers were going down.

Well, they were. Here are changes in trends over the past 30 years:

• We were making great progress. In 1999, the Centers for Disease Control and Prevention published a report showing how heart-related deaths had declined by 60% from 1900 to 1990. They called this success “one of the most important public health achievements of the 20th century.”
• That continued. Overall heart disease deaths in the U.S. continued to decline from 2010 to 2019.
• Until 2020. This overall lower trend reversed during 2020, and heart-related deaths have continued to be higher than expected through 2022.
• Now, it’s bad. In their paper published in the American Journal of Preventive Medicine, Woodruff et al. said that this concerning increase represented “almost a decade of lost progress” on the fight against heart disease.

But, isn’t this increase in heart disease deaths due to COVID-19?

For many of the excess deaths between 2020 to 2022, most certainly yes. There was an important clue, however, in a paper from Bae et al. that forewarns of a bigger problem.

In their study, they evaluated underlying heart-related risk factors for those who developed severe COVID-19. Unexpectedly, they found that younger people (< 50 years old) who had hypertension, diabetes, and heart disease were at a higher risk of dying from COVID-19 compared to older people with these same underlying conditions. This study suggested that something bad, even prior to COVID-19, may be brewing in younger people.

Something is amiss in younger people.

Similar to older people, heart-related deaths in younger people (25 to 64 years old) had been dramatically declining. But these trends were reversing in young people long before COVID-19. In fact, as reviewed by Ritchey et al., nearly two-thirds of U.S. counties saw increasing heart-related deaths among people 35 to 64 years old during 2010 through 2017.

This rise in heart-related deaths among younger people (called “premature heart disease mortality”) has led to calls to action for what Manolis et al. characterize as “a sobering reality.”

What are the risk factors for heart disease in our youngest folks?

In the American Heart Association’s 2023 Update on Heart Disease, they showed the following risk factors among our younger populations:

• Low physical activity. Only 20% of 6 to 17-year olds were active at least 60 minutes a day every day of the week.
• Poor diet. Using a standardized score to evaluate diet quality, with a range of 0 (lowest) to 100 (highest), 12 to 19-year olds had a diet score of 28. Hello chips, cookies, and carbs.
• High BMI. For many of the reasons above, more than 1 in 3 (37%) kids between 2 to 19 years old are overweight.

While all of these are known risk factors for heart disease, it doesn’t really explain why deaths from heart disease in younger adults have been increasing more recently… like, in the past decade.

For kids and adolescents, overall cigarette use is down, kids aren’t necessarily less active than they were 20 years ago, and most teens have historically eaten cruddy diets (remember what you used to eat as a 16-year old?).

Further, many young people have moved from cow’s milk (once seen as a harmful source of bad saturated fats) to “healthy” plant-based milks, and cholesterol-lowering medications have been implemented for decades. On almost all fronts, cardiovascular diseases should be decreasing among younger people.

So, what’s going on?