Roundup: ‘Under-Recognized’ Causes of Heart Attacks in Adults Under 65; and More News

‘Under-Recognized’ Heart Attack Causes in Younger Adults: Study Finds Key Differences for Women

New research has revealed that many heart attacks in people under the age of 65 — especially women — are not caused by clogged arteries, as it is widely assumed. Instead, a range of nontraditional conditions, such as spontaneous coronary artery dissection (SCAD) and stress-related triggers, are often to blame. These findings could reshape how physicians diagnose and treat heart attacks in younger populations.

Beyond Clogged Arteries

For decades, the medical community has viewed atherosclerosis — the buildup of fatty plaque in the arteries — as the leading cause of heart attacks. While this remains true for most men and many women, the new research demonstrates that it is not the full story.

Analyzing 15 years of data from the Rochester Epidemiology Project, researchers from the Mayo Clinic examined 1,474 heart attacks in patients aged 65 and younger. While 68 percent of these events were due to traditional plaque buildup, more than half of women’s heart attacks were caused by other mechanisms. In men, 75 percent of cases were plaque-related, but in women, this figure dropped to just 47 percent.

Women and SCAD: A Hidden Risk

One of the most striking findings was the prevalence of spontaneous coronary artery dissection, or SCAD. This condition occurs when a tear forms in the coronary artery wall, disrupting blood flow and triggering a heart attack. Unlike plaque-related disease, SCAD often affects younger, otherwise healthy women who may not have typical cardiovascular risk factors.

The study revealed that SCAD was nearly six times more common in women than men. Alarmingly, more than half of SCAD cases were initially misclassified as plaque-related heart attacks, leading to treatments such as stenting that may be unnecessary or even harmful.

“This research shines a spotlight on heart attack causes that have historically been under-recognized, particularly in women,” said Claire Raphael, M.D., an interventional cardiologist at Mayo Clinic and first author of the study, in a news release. “When the root cause of a heart attack is misunderstood, it can lead to treatments that are less effective — or even harmful.”

Deadliest but Overlooked Causes

The study also identified heart attacks triggered by physical stressors, such as severe anemia or infection. Though these patients often had less damage to the heart muscle, they experienced the highest five-year mortality rate — about 33 percent. This underscores the importance of recognizing and treating stress-related heart events with urgency.

Other less common causes included embolism (blood clots traveling to the coronary arteries), vasospasm (sudden narrowing of the arteries), and rare unexplained cases. Together, these nontraditional mechanisms made up a substantial share of heart attacks, particularly in women.

Implications for Patients and Physicians

The study’s findings highlight the need for greater awareness of the diversity of heart attack causes. Misdiagnosing a SCAD as a typical atherosclerotic heart attack, for example, could lead to unnecessary procedures and complications. By tailoring diagnosis and treatment to the specific cause, physicians can improve long-term outcomes.

“Understanding why a heart attack happened is just as important as treating it,” emphasized Dr. Raphael. “It can mean the difference between recovery and recurrence.”

Rajiv Gulati, M.D., chair of Interventional Cardiology and senior author of the study, added in a news release: “Our research highlights the larger need to rethink how we approach heart attacks in this patient population, and for younger adult women, in particular.”

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Study: ‘Alcohol-Induced Deaths’ in U.S. has Doubled Over 25 Years

An analysis of 25 years of national mortality data has found that “alcohol-induced” deaths nearly doubled between 1999 and 2024. The study, published in PLOS Global Public Health, also highlights how the COVID-19 pandemic accelerated these losses, with fatalities peaking in 2021.

The analysis led by researchers at UCLA (University of California, Los Angeles), which drew on the U.S. Centers for Disease Control and Prevention’s National Vital Statistics System, examined 14 alcohol-induced causes of death. These included conditions such as alcoholic liver disease and alcohol-related mental and behavioral disorders.

• Overall Trends: Alcohol-induced mortality rose significantly, with deaths reaching their highest level in 2021 at 54,258 lives lost. By 2024, rates declined slightly but remained about 25 percent higher than in 2019.
• Demographic Disparities: Men continue to die at higher rates from alcohol-induced causes than women. However, the steepest rise occurred among women aged 25–34, whose death rates increased by 255 percent over the study period.
• Most Affected Communities: American Indian and Alaska Native (AIAN) populations experienced the greatest burden. Male AIAN alcohol-induced death rates were three times higher than white males, and female AIAN rates were four times higher than white females.
• Young Adults: Among men aged 25–34, deaths rose 188 percent, from 2.3 per 100,000 people in 1999 to 6.5 in 2024.

The Impact of the COVID-19 Pandemic

The researchers point to the pandemic as a turning point in the trajectory of alcohol-related mortality. Between 2019 and 2021, stress from isolation, disruptions in health care, and reduced access to treatment for alcohol-use disorders fueled a sharp surge.

“The rise in alcohol-induced mortality is widespread and affects the entire country,” the study notes. In the early months of the pandemic, alcohol-induced deaths among AIAN males increased by as much as 40 percent in a single month. Similarly, AIAN and Black females experienced more than a 30 percent monthly rise in some cases.

Although men historically have had higher alcohol-induced death rates, the study reveals a narrowing gender gap. Senior author Maria R. D’Orsogna, Ph.D., explains in a news release: “The rapid rise of alcohol-induced deaths among women is particularly concerning. Although men still die at higher rates, the gender gap appears to be closing.” Among adults aged 25–34, the male-to-female mortality ratio shifted from three-to-one in 1999 to two-to-one in 2024.

Broader Implications

It is important to note that the study did not include deaths from chronic conditions linked to long-term alcohol use, such as certain cancers or heart disease. This means that the true toll of alcohol on public health is likely higher than reported.

The findings underscore the need for stronger public health interventions. These may include policies to curb excessive drinking, targeted outreach in high-risk communities, and expanded access to treatment programs.

The doubling of alcohol-induced deaths over 25 years reflects a significant public health challenge, researchers say. While the worst of the pandemic surge has eased, current mortality rates remain well above pre-pandemic levels. Addressing this crisis will require a combination of prevention strategies, improved treatment access, and sustained awareness of alcohol’s risks.

Early Brain Changes Detected in Athletes Exposed to Repetitive Head Impacts

A new study funded by the National Institutes of Health (NIH) focused on the effects of repeated head impacts in contact sports. Rather than waiting until severe symptoms or advanced disease appear, researchers found evidence that the brains of young and middle-aged athletes may experience significant alterations long before chronic traumatic encephalopathy (CTE) is diagnosed.

CTE is a progressive brain disease previously thought to be detectable only after death through tissue examination. These new findings point to the existence of subtle, early brain changes that could transform how head injuries in sports are understood, diagnosed, and ultimately, prevented.

“This study underscores that many changes in the brain can occur after repetitive head impacts,” said Walter Koroshetz, M.D., director of NIH’s National Institute of Neurological Disorders and Stroke (NINDS), in a news release. “These early brain changes might help diagnose and treat CTE earlier than is currently possible now.”

Beyond Tau Protein Buildup

Scientists have long identified the hallmark of CTE as the buildup of a protein called tau in nerve cells. This new study, however, looked deeper. Researchers at the Boston University CTE Center and partner institutions analyzed postmortem brain tissue from athletes under age 51, most of whom played American football. Using advanced tools to examine individual cells, they uncovered changes that occurred even without the presence of tau protein.

The study found a striking 56 percent loss of specific neurons, or nerve cells, in a brain region that often absorbs force during head impacts. This loss was directly related to the number of years an athlete was exposed to repetitive head impacts. This suggests that nerve cell damage can happen much earlier than the visible signs of CTE. Additionally, the brain’s immune cells, known as microglia, showed increased activity that correlated with the years spent playing contact sports.

Blood Vessel and Cellular Communication Changes

The research also highlighted important molecular changes within the brain's small blood vessels. The team observed gene patterns that pointed to immune system activity and a possible response to lower oxygen levels in nearby brain tissue. They also noted a thickening and growth of these small blood vessels.

Moreover, the scientists identified a previously unknown communication pathway between the microglia (immune cells) and the cells of the blood vessels. The study's authors propose that this interaction might explain how these early cellular problems could set the stage for disease progression long before CTE becomes fully apparent.

This study is among the first to concentrate on younger athletes, shifting the focus from advanced CTE in older individuals to the earliest cellular signs of damage. By identifying these initial warning signs, this work paves the way for developing new methods to detect the effects of head injuries. Ultimately, this could lead to interventions that prevent the devastating consequences of CTE.