A recent study by scientists at the Mayo Clinic has revealed that more than 50% of heart attacks in women aged 65 or younger are not caused by traditional factors such as clogged arteries. The research analyzed 1,474 heart attack events recorded in Olmsted County, Minnesota, between 2003 and 2018. This significant finding challenges the longstanding belief that atherothrombosis, which involves blood clots blocking artery flow, is the primary cause of heart attacks in this demographic.
The study findings indicate that while atherothrombosis was responsible for 75% of heart attacks in men, it accounted for only 47% in women. The implications of this research are profound, particularly for the prevention and treatment of heart attacks among younger women.
Understanding New Causes of Heart Attacks
Cardiologist Claire Raphael, one of the authors of the study, emphasized the importance of recognizing these alternative causes. “This research shines a spotlight on heart attack causes that have historically been under-recognized, particularly in women,” she stated. Misunderstanding the root causes of heart attacks can lead to ineffective or even harmful treatments.
The study found that 34% of heart attacks in women were linked to supply/demand mismatch secondary myocardial infarctions (SSDMs). This condition arises when the body experiences an imbalance between oxygen supply and demand due to stressors like anemia or infection. Other significant contributors to heart attacks included spontaneous coronary artery dissections (SCADs) and embolisms, where blood clots travel from other body areas.
In the analysis, the researchers noted that SSDMs were the most common cause of heart attacks in women aged 45 years or younger. They found that acute non-atherothrombotic coronary causes like SCAD, embolism, and other stress-related triggers were collectively as prevalent as atherothrombosis in this group.
Implications for Diagnosis and Treatment
The study’s authors observed that individuals who experienced SSDMs had the highest mortality rates within five years, potentially due to underlying non-cardiac diseases. Notably, many heart attacks attributed to SCAD were initially misdiagnosed as atherothrombosis, particularly in women, where SCAD was identified nearly six times more frequently.
Cardiologist Rajiv Gulati highlighted the need for healthcare professionals to enhance their awareness of conditions like SCAD and embolism. He urged patients to advocate for themselves when they experience symptoms that do not feel right. The study suggests that future research should explore the differences in heart attack risk factors between genders, particularly why women may present with different symptoms or seek medical help less frequently.
In the United States, a heart attack occurs approximately every 40 seconds, underscoring the urgency of understanding risk factors, which include urban living, diet, and environmental pollution. The research team noted that although advancements in heart imaging technology have improved diagnosis and prevention, existing screening techniques may still miss nearly half of those at risk of experiencing a heart attack.
The study pointed to the common practice of assessing heart attack risk using an atherosclerotic cardiovascular disease (ASCVD) score. This score considers various factors linked to cardiovascular disease development. Alarmingly, an analysis of health records from 465 patients aged 65 years or younger revealed that two days prior to their heart attack, 45% would have been classified as low or borderline risk.
Raphael, Gulati, and their colleagues are advocating for greater awareness of alternative causes of heart attacks among both health professionals and the general public. “Understanding why a heart attack happened is just as important as treating it,” Raphael concluded. “It can mean the difference between recovery and recurrence.”
This pivotal research was published in the Journal of the American College of Cardiology in September 2025, marking a significant contribution to the ongoing conversation about heart health, particularly for younger women.
