Healthy heart. Healthy life.
Dr. James Aw, Chief Medical Officer, OMERS
March 10, 2025
This February was Heart Health month, an opportunity for all of us to think about our well-being and what we can do to take care of our hearts now and in the future. In honour of this, I’ve collected some questions and related research pertaining to each.
At what age should I start worrying about my heart?
Early onset of atherosclerosis (thickening of the arteries from fatty deposits) can begin as early as the 20s and 30s (Autopsy studies found 20% of men and 8% of women were aged 30-34 yrs). However, significant atherosclerosis (hardening of the arteries from plaque) causing heart disease (symptoms) usually happens when you are older and occurs in most adults past the age of 60 (the average age of a first heart attack is 65 years old for men and 72 for women). Age is an independent risk factor for heart disease and increases in your 40s. Younger people (less than age 40) can have heart disease if they have additional risk factors (obesity, lack of exercise, diabetes, high blood pressure and lipids, family history of premature heart disease, smoking, etc.) and the incidence is rising in this group.
Smoking is the strongest associated risk factor for coronary artery disease in young adults, as well as being male. Studies suggest that 5-10% of heart attacks occur in adults under age 40. Younger adults may also have autoimmune diseases and connective tissue disorders that increase their risk. Spontaneous coronary artery dissection (SCAD) is rare in young women and one-third of cases occur during pregnancy. Infections (chlamydia, mycoplasma, Helicobacter pylori) leading to chronic systemic inflammation may also be associated with heart disease.
Substance use (i.e. cocaine, marijuana, etc.) and tobacco are also factors in heart attacks in young adults. Abuse of amphetamine-type stimulants (methamphetamine – “meth” and abuse of ADHD drugs) can also lead to heart complications.
Parents should also promote healthy lifestyles for their growing children to avoid future risks. Obesity, inactivity and unhealthy diets are modifiable risk factors, and I have previously discussed picky eaters. The American Health Association has developed the Life’s Essential 8™ for Kids, which focuses on concepts named balanced bodies, building blocks, clean air, don’t be pressured, in motion, sleep tight, super fuel and sweet talk.
Below I’ve reproduced Johns Hopkins Medicine’s Heart Smart Guide at every age.
Your 20s and 30s: Start Strong
Don’t smoke
Mediterranean Diet
Try sports and activities
Find healthy stress outlets
Cool down with relaxation or anger management classes
Your 40s: Build Good Habits
Keep moving
Home-cooked meals
Track your numbers – blood pressure, cholesterol, blood sugar
Watch weight
Avoid self-medicating when under stress – food, alcohol, pills, cigarettes
Your 50s: Stay on Track
Good lifestyle choices
Report unusual symptoms to your doctor
Don’t ignore sleep problems
Learn the symptoms of heart attack and stroke
Your 60s: Beat the Risks
Discuss your risk of heart attack and stroke with your doctor
Keep trying
Manage chronic conditions with your doctor – take your meds
Add (or keep up) weight-bearing exercise
Your 70s+: Focus on Health
Be sure that all your doctors are up to date on what’s going on with you – communication with your team
Don’t ignore worrisome symptoms
Keep up with preventative health care
What about family history?
Significant family history usually means in a first-degree relative – parent/sibling prior to age 55 (males) or 65 (females) or more broadly a history of strokes, transient ischemic attacks, congestive heart failure, peripheral artery disease and aortic aneurysms. Familial hypercholesterolemia (inability to remove LDL cholesterol from the bloodstream) is a hereditary condition whereby family members have very high levels of cholesterol even at a young age. There are rare genetic disorders occurring in families (i.e. sudden death syndromes, arrhythmias – Long QT, Brugada, Wolf Parkinson White, congenital heart disease, etc.) that are also important to discuss with your physician. Polygenic risk scores are another tool to assess genetic risk. A strong family history should prompt you to focus on heart health at a younger age.
Which groups have unique risks?
It is commonly understood that men have a higher incidence of coronary heart disease mainly because of high cholesterol, and they tend to develop heart disease decades earlier than women. However, what you may not be aware is that heart disease is the #1 cause of death in both men and women – above cancer. It’s also important to note that other groups also face unique risks related to heart disease and that these are intersectional.
Women may have hormonal effects from birth control contraceptive medication, polycystic ovarian syndrome, pregnancy and early menopause. High blood pressure and diabetes during pregnancy (pre-eclampsia, gestational diabetes) can increase future lifetime risk of heart disease. Women with diabetes have worse heart health outcomes compared to men with diabetes. Women may also be more prone to autoimmune disorders (lupus, rheumatoid arthritis) that are linked to heart disease and women with diabetes have more cardiovascular events. Breast cancer may also increase the risk of cardiovascular disease. The “multiple hit” theory implies that the risk comes from the combined effects of traditional risk factors, side effects from cancer therapy on heart function and decreased physical activity during treatment. Women may also not have the typical symptoms of heart attack and may present with other symptoms like shortness of breath, nausea, dizziness, abdominal pain and fatigue.
Individuals with visible and invisible disabilities may also present with atypical heart symptoms and have complex co-existing medical conditions. They may delay seeking care or feel their symptoms are brushed off and falsely attributed to their disability. It is important for these individuals to have access to advocates who can help navigate the healthcare diagnostic and treatment journey. Intersectionality is also a factor when individuals have multiple unique heart risk factors.
Individuals of different racial background also present with unique risk factors and higher rates of heart disease.
Indigenous peoples in Canada have higher rates of heart and mental health illnesses, with higher rates of risk factors such as obesity, diabetes, smoking and physical inactivity. Social determinants and the need to incorporate culturally appropriate care may improve better future health outcomes.
Black persons have a higher risk for high blood pressure, cardiovascular disease and are 2-3 times more likely to die from heart disease than other racial groups. Black women also have a higher burden of pregnancy-related hypertension. Black and Hispanic persons have higher rates of obesity (particularly women), diabetes and hypertension. Black persons develop hypertension-related complications at a younger age, have more severe and resistant hypertension, but are more responsive to salt restriction (DASH diet) for hypertension. The choice of medication should also be tailored based on ethnicity. Social determinants of health are also reasons for race/ethnicity disparities in North America.
South Asian people (India, Pakistan, Bangladesh, Sri Lanka and Nepal) tend to present with obstructive coronary artery disease at a younger age (with severe multivessel disease) and have a higher prevalence of high cholesterol, diabetes and death from coronary heart disease. South Asian immigrants have the highest rates of acute heart attacks in Canada, with higher rates of diabetes, abnormal lipids, increased inflammatory and clotting factors. Other risk factors include central obesity, low rates of physical activity, poor dietary habits and genetics. The subpopulations with the highest risk are Pakistani, Bangladeshi and Indian. East Asians (China, Japan, Vietnam, Korea, Hong Kong and Taiwan) tend to have a lower prevalence of cardiovascular risk factor and heart attacks.
There is conflicting evidence on whether there is increased cardiovascular risk in LGBTQ (lesbian, gay, bisexual, transgender, queer) groups. Risk may be attributable to the prevalence of traditional factors of tobacco, alcohol, physical inactivity, obesity and psychosocial stress in certain groups (particularly sexual minority women – lesbian, gay, bisexual or “something else”). It is unclear whether transgender women are at increased risk of heart attacks, strokes and clots because of gender-affirming hormone therapy (estrogens) or their sex at birth (i.e. male). There is no clear evidence of increased risk in transgender men from masculinizing hormone therapy. More studies are needed. Intersectionality is a framework that consider the interaction of social factors (race, sexual identity) that may lead to different experiences of discrimination and privilege that can influence cardiovascular risk.
Is heart disease preventable?
Yes! Studies have found that over 90% of heart attacks are attributable to nine risk factors that include smoking, high cholesterol, high blood pressure, diabetes, obesity, diet, physical activity, alcohol and psychosocial factors (i.e. stress).
Staying active, eating healthy and speaking with your doctor, advocating for your health or the health of your loved ones is the best way to heart healthy. You can even do it at work – which has been shown to have a positive impact on heart health. Heart health in the workplace can include daily physical activity (i.e. classes, fitness gym, walking meetings, etc.), mind recharging (meditation, social connections, psychological safety), healthy eating choices, health screening (biometrics) and adherence to prescribed medication (i.e. high blood pressure, cholesterol, diabetes, etc.).
A healthy heart is a healthy life! Heart disease is preventable, treatable and the workplace can have a positive impact to promote healthy heart habits!
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