About two years ago, Kristina Auwarter was leaning over to pick up her son from his crib when she felt a spot of pain bloom in her chest. Initially, nothing about it raised her suspicion; she’d just finished a workout and felt fine throughout it, and she’d been tending to her health as of late, earning great marks on all her blood work. She popped a few Tums, assuming it was heartburn. The pain worsened, creeping up into her jaw and down her left arm, and she grew sweaty, despite it being a crisp fall day. For a moment, she thought that it could be a heart attack, “but then the logical side of me was like, ‘You’re 35; you’re healthy. It’s probably just a panic attack,’” Auwarter tells SELF. If it wasn’t for her sister, who lived with her and was home that day from work, she probably wouldn’t have called 9-1-1, she says. She’d learn within minutes of arriving at the hospital that she was indeed having a heart attack—a total blockage in the largest of the three arteries that feed the heart.
Auwarter is far from the model patient for a heart attack, which is generally perceived as an older man’s condition and occurs when part of the blood flow to your heart gets impeded. While heart disease is the number one killer of both women and men in the US, men do face more attacks than women overall. But recent data suggests the threat is skewing younger and more female: A large 2018 study found a diverging trend line among heart attack patients under age 54 between 1995 and 2014, with the share of young women being hospitalized for a heart attack jumping up 10%, even as the proportion of young men in this bucket stayed stable. And research from 2019 uncovered a steadily climbing rate of heart attack in people under age 40, up 2% each year from 2000 to 2016.
For women, the long-term fallout of an early-in-life heart attack is also magnified. A host of studies have shown that young female heart attack sufferers are less likely than their male counterparts to get certain tests and treatments, and more likely to wind up back in the hospital and to die from heart disease.
Read on to learn why the face of heart attack is shifting, what can stand in the way of spotting and treating the condition in young women, and how to lessen your risk.
Why young women are increasingly at risk for heart attack
Part of the growing threat reflects the broader dips in cardiometabolic health we’re seeing society-wide, Emily Lau, MD, MPH, a board-certified cardiologist and director of the Women’s Heart Health Program at Brigham and Women’s Hospital, tells SELF. Traditional risk factors like high blood pressure, high cholesterol, and high blood sugar—which contribute to plaque buildup in arteries—have been on the rise due to lifestyle trends toward eating less nutritiously and sitting more. Hormonal conditions, like polycystic ovary syndrome (PCOS), can spur on some of these problems more swiftly in women, and research suggests women may be extra vulnerable to the consequences of smoking (another risk factor) on the heart.
But there’s also a “whole bucket of nontraditional risk factors for heart attack” that affect young women and have become increasingly prevalent, Amy Ahnert, MD, a board-certified cardiologist with Atlantic Medical Group and director of the Women’s Heart Program at Morristown Medical Center in New Jersey, tells SELF. Among them are adverse pregnancy outcomes, like hypertensive disorders, which are conditions of high blood pressure during pregnancy (like preeclampsia), and gestational diabetes. Rates of the former have doubled in the past two decades, and rates of the latter have risen by roughly 30%, likely driven by spikes in pre-pregnancy health issues and less heart-supportive lifestyle behaviors.
“Historically, we thought these conditions were dangerous during pregnancy, but then you delivered and they didn’t have any residual effects,” Dr. Ahnert says. But now, we know they can have lasting ramifications, she says, with studies showing the above complications bump up your risk of future cardiovascular disease, like heart attack, by twofold or more. As for why? Experts think they may surface a once-hidden predisposition for heart problems, or even prompt inflammation or damage to arteries that can stick around.
At the same time, women are about twice as likely as men to have a mental health condition, which poses a unique threat to their hearts too. For instance, women with depression are at higher risk of developing a cardiovascular issue than men with the condition, and psychological distress trickles into greater likelihood of a future heart problem for women…but not men. Researchers theorize that women may be subject to more intense mental symptoms or a weightier biological response to stress, perhaps leading to greater heart-related consequences down the line.
One final factor is the climb of autoimmune diseases, which are twice as common in women versus men (possibly due to the influence of estrogen and sex-specific genes on the immune system). These conditions, like lupus and rheumatoid arthritis, involve inflammation, which could translate into higher heart attack risk over time by harming the lining of blood vessels.
The big problem, says Dr. Ahnert, is that none of these atypical risk-raisers is included in the tools used by doctors to assess a person’s likelihood of a heart event, so “providers are often completely missing the opportunity to intervene [for young women],” she says. Indeed, in a study of 3,500 young people who had a heart attack, the women were significantly less likely to report that their doctor mentioned their risk or started a convo about heart disease at all.
How heart attacks in young women often wind up missed, misdiagnosed, or mistreated
Because of the sex-based stereotypes surrounding heart attacks, it often doesn’t occur to young women that they may be having one when symptoms strike, even if it’s the categorical chest pain, Dr. Lau says. On the flip side, it’s been so widely reported that women do not always get the textbook heart attack symptoms seen in men, that some women may blow off their chest pain, she adds. But two things can be true: Some degree of chest pain or heaviness remains the most common sign across sexes, and also, women tend to get other not-so-typical symptoms too—which could mean the chest discomfort is just not top of mind, Harmony Reynolds, MD, a board-certified cardiologist and director of the Sarah Ross Soter Center for Women’s Cardiovascular Research at NYU Langone, tells SELF.
These atypical symptoms can encompass pain or tightness spanning “from jaw to belly button,” Dr. Reynolds says, as well as shortness of breath, sweating, fatigue, nausea, or just a sensation of feeling off. She finds that young women are also caught off guard by the fact that it doesn’t have to be unbearable or even outright painful; it could just feel unfamiliar, which can make it even less likely that you suspect a heart attack. Add to that the ways in which women are disproportionately brushed off by doctors, and it’s no wonder you might not seek care. Dr. Ahnert points to a study that found women are more likely to call an ambulance for a male partner with heart attack symptoms than for themselves. Chalking it all up to anxiety or stress, as Auwarter initially did, may seem more practical, especially if you’re time-strapped as the head of your household or primary caregiver.
What can further obscure a heart attack diagnosis is if it happens for an unusual reason, which doctors have recently discovered is far more common in young women versus men. A 2025 Mayo Clinic study suggests more than half of heart attacks in women under 65 are set off by triggers that have nothing to do with the classic artery-clogging plaque—for instance, a traveling blood clot, spasming artery, or torn artery wall, a.k.a. spontaneous coronary artery dissection (SCAD)—compared to just 25% in men. Auwarter’s heart attack, for one, was the result of SCAD, diagnoses of which are 90% female. Doctors don’t yet know the root cause of these atypical attacks (or why they skew female) but suspect that genetic factors tied to blood vessel size and function, hormone fluctuations, and the effects of intense physical or emotional stressors may play a role. Because these scenarios don’t hinge on plaque buildup, they can and do occur in women with zero traditional risk factors, Dr. Reynolds says, which can majorly delay detection.
Take Kayla Wolthoff, for example, who was 30, the “healthy one of my friend group,” and a fitness instructor when she first experienced a pain between her shoulder blades that radiated to her chest. It happened on and off for a couple weeks, leading her to believe it was acid reflux. But two months in, Wolthoff felt so exhausted she “could hardly stay awake,” she tells SELF; she had also started vomiting. She saw a doctor, only to be told it was probably her anxiety. Even when she collapsed coming out of the shower and went to the emergency room, her chest pain spreading to her jaw, she waited two hours for care. “I don’t think people were connecting the dots,” she says, given she appeared young and fit.
By the time a nurse finally checked her heart rate and blood pressure, “they thought something was wrong with the monitor,” she says. An electrocardiogram (EKG), which records the heart’s electrical activity, showed a “tombstone rhythm,” indicative of a 100% blockage: a massive heart attack. Doctors would later suspect the tear in an artery, or SCAD, that caused the event likely happened when she first felt pain weeks prior, and over time, limited more and more blood from reaching her heart.
In other scenarios, these kinds of unusual and predominantly female heart attack types aren’t even obvious on tests for heart issues. A non-plaque-related blockage won’t necessarily spark an abnormal EKG, Dr. Reynolds says. “You have to ask for a blood test that checks your level of troponin,” which leaks from a damaged heart, to know for sure if you’ve had a heart attack, she says. But even this doesn’t indicate the cause. And when a doctor visualizes your arteries (via a coronary angiogram) to determine what went wrong, “you don’t always see anything, like you would with a plaque-related blockage,” Dr. Ahnert says. A small artery tear or spasm, for instance, may be invisible or heal on its own prior to the scan.
That means, if a woman’s heart stabilizes, she may be sent home without learning the underlying reason for her attack or getting treatment for it, Dr. Ahnert says. In fact, the 2018 study above on rising rates of heart attack in young women showed that they are less likely than men with the condition to receive certain medications to thin blood and safeguard the heart (despite facing similar risks of death or a future cardiac issue).
How to lower your odds of having a heart attack—or long-term damage from one
Your first step, all the experts say, is to get a sense of your personal risk, no matter how young you may be. “When you’re in your 20s or 30s, or even early 40s, you’re not necessarily thinking about your blood pressure, cholesterol level, or sugar control,” Dr. Lau says, “but it’s critically important to have these factors on your radar.” It’s the cumulative exposure [to these risks] that really wreaks havoc on your heart, she points out.
That means carving out the time for annual doctor visits and getting those key tests at the cadence your provider suggests. Typically, you’ll have a blood pressure check each year; cholesterol, every four to six years; and blood sugar, every three years, beginning at age 35—but you may need to test sooner or more frequently depending on your lifestyle, health, and whether you have a family history of heart disease. And if things come back slightly off, “don’t accept borderline as an answer and move on,” Dr. Reynolds cautions. That should prompt you to ask about closer monitoring and the best tactics for you to knock those numbers down, she says. Too often, she adds, she cares for women who presumed they were in the clear after “borderline” results and then wound up having a heart attack.
Even if you’re in good shape numbers-wise, remember that your risk could be far from zero. It’s the reason Dr. Ahnert emphasizes that all young women embrace as many heart-healthy habits as possible, like eating a nutritious plant-forward diet, moving your body often, and getting good sleep. If it only feels practical to do one of these things or make little adjustments (10 minutes of exercise, one more vegetable), that’s worthwhile, she says. She often treats young women who say they’re just too busy caring for others to take on these practices, and will gently remind them: “It’s not selfish to take care of yourself.”
That applies equally to your mental health. “It’s as important as the physical,” Dr. Lau says, particularly given the major impact of mental distress on women’s hearts.
All this said, the non-plaque-related heart attacks that crop up in healthy women, like the SCAD that hit Auwarter and Wolthoff, still mostly evade explanation—meaning, we don’t know how to prevent them, Dr. Reynolds says. As with so many conditions, we desperately need more research on heart attacks in women, particularly young ones, to get a better handle on this threat. But one thing is clear: Both women survived and went on to thrive in their recovery in part because of their otherwise good health and fitness.
Wolthoff, however, lives with heart failure now, “because mine wasn’t caught early enough,” she says. The dearth of blood her heart received for the months she went without treatment caused permanent damage, so the functional parts now have to work much harder, leading her to get “extremely tired extremely quickly,” she says. If there’s anything she hopes others can learn from her story, it’s the life-saving importance of awareness—being able to clearly spot heart attack symptoms, no matter your age or sex—and advocating for yourself. “It’s tempting to downplay pain,” she says. “But you know your body best. If something feels wrong, it likely is. Your intuition is right. And if a doctor is writing you off, find another one.”
Related:
- A Black Cardiologist Shares the #1 Thing She Does to Prevent Heart Disease
- I Had a Heart Attack at 34. Here’s the First Symptom I Experienced
- 6 Signs of Heart Problems Even Young People Should Know
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