TUESDAY, Feb. 18, 2003 (HealthDayNews) -- If you're under 40 and are at risk of heart disease because of diabetes, smoking or obesity, you'd better get serious about taking better care of yourself.
One of every three people diagnosed with coronary artery disease before age 40 dies within 15 years, says new research. For those with diabetes, the death rate was nearly two out of three.
"Their mortality rate is so dramatic," says study author Dr. Joe Miller III, an assistant professor of preventative cardiology at Emory University School of Medicine in Atlanta. "A third of them were dead at follow-up. It's a little shocking."
For the study, which appears in the Feb. 19 issue of the Journal of the American College of Cardiology, Miller and his colleagues analyzed the medical records of 843 heart patients under age 40 listed in the Emory Cardiac Database. All of the patients had at least one documented coronary artery blockage between 1975 and 1985.
The mean age at diagnosis for men was 36; for women, it was 35.
By age 50, nearly one-third of the patients had died. Two-thirds of those who had diabetes were dead.
The death rate was highest among those who had suffered a prior heart attack or had been diagnosed with heart failure. Smoking also dramatically increased the chance of dying.
Heart patients who continue to smoke had a six times greater chance of dying than those who didn't smoke. Those who quit smoking fared better. Former smokers' risk was about the same as those who'd never smoked.
"It really shows how bad smoking is for people," Miller says. "Even if you treat diabetes aggressively, if you lower cholesterol and treat blood pressure aggressively, if you continue to smoke, your risk does not go down."
Dr. Daniel Fisher, a cardiologist at New York University Medical Center in New York City, says he's not surprised by the findings.
"We know that young people with coronary artery disease, especially those with diabetes or who smoke, are going to be at a very high risk of mortality," Fisher says.
And he believes the incidence of early death from heart disease is going to continue to rise with the "epidemic of obesity."
"We are going to see a shift away from heart disease being thought of as only a disease of older people," he adds.
Diagnoses for coronary artery blockages are still somewhat unusual in younger adults. Most studies estimate only about 3 percent of people treated for blockages are under age 40, Dr. Lloyd Klein writes in commentary that accompanies the journal article.
"It must be noted, however, that those patients who come to medical attention owing to symptomatic disease may well represent the tip of the iceberg," Klein writes.
"The prevalence of the disease has been grossly underestimated," he adds.
In a recent study of transplanted hearts, researchers found more than half of the teenagers involved had the beginnings of coronary artery disease; one in six teenagers had "coronary lesions."
Doctors aren't sure why some people develop blockages so young, while others have similar lifestyles but don't need treatment until old age. It's almost certainly some combination of genetics and lifestyle, Fisher says.
"We don't know exactly the trigger," Fisher says. "It's very clear there are risk factors for heart disease -- diabetes, smoking, obesity, high blood pressure, family history. But we're not sure why some people with these same risk factors will have heart disease younger, while some won't develop heart disease until later."
The study also found heart patients treated by surgical techniques such as angioplasty fared better than those treated by drugs alone.
However, Fisher notes that new and better medicines, such as cholesterol-lowering statins, have been developed since the 1970s and 1980s, when these patients were seen.
What's certain is, if you're at risk of heart disease, you should see a doctor to get your cholesterol, blood pressure and blood glucose levels tested.
And start taking steps to improve your health: Lose weight. Quit smoking. Exercise. Eat a balanced diet.
Your life could depend on it, Fisher says.
"You should take your health seriously even at an early age," he adds.
More information
The American Heart Association has tips for improving your heart health.
The National Heart, Lung and Blood Institute also has extensive information on many aspects of heart health.
