Statistics show that sudden cardiac arrest among young athletes is a high-impact but low-probability event. Though it is the leading cause of exercise-related death in young, competitive athletes — accounting for 75% of fatalities during sports or exercise — cardiac arrest will claim roughly one in 50,000 to 80,000 of young athletes each year, the Mayo Clinic reports

Dr. Hussam Suradi, associate professor of medicine and pediatrics and specialist with the Division of Cardiovascular medicine at Rush University Medical Center, says significant heart problems in young athletes are linked primarily to genetic or congenital abnormalities.

“More specifically, young athletes who develop cardiac issues are most likely to have been born with these problems, and these problems have remained dormant and asymptomatic since birth until, for example, triggered by an exertional or traumatic event,” he said.

Data that suggests higher rates of cardiac issues in young athletes is likely a result of better record keeping, more available diagnostic testing and more  publicity, Suradi says.

However, young athletes’ cardiac emergencies in the news is also bringing attention to a second issue: An increase in heart attacks among young people in general.

It’s a tale of two issues, says Dr. R. Kannan Mutharasan, medical director of Northwestern Medicine Bluhm Cardiovascular Institute at Palos Hospital.

“One issue is highlighting the other,” he says. “We are seeing an uptick in conventional heart attacks in younger patients.”

Data released last few years has shown more people younger than 40 are having heart attacks. According to the American College of Cardiology, a study conducted between 2000 and 2016 found that the proportion of young people having a heart attack rose by 2% each year for individuals in their 20s or 30s.

“The reason why we’re seeing people younger and younger having heart attacks is because their risk factors are increasing — obesity, diabetes, cholesterol, eating processed foods,” Mutharasan said. “Their bodies are aging quicker because of all of these risk factors.”

Dr. Ben Chung, a cardiologist with UChicago Medicine who sees patients in Munster, says rising incidence of obesity across all age groups is the largest factor.

“Obesity causes a syndrome that can create all kinds of other health issues – high blood pressure, high cholesterol, diabetes,” he said. “All of these are risk factors for coronary artery disease, which can lead to a heart attack.”

The use of vaping and e-cigarettes can be an additional risk factor, Chung says. According to the U.S. Centers for Disease Control, more than 2.5 million U.S. youth reported e-cigarette use in 2022.

“There’s a misperception that vaping is safer than traditional cigarettes, but the truth is that they are still linked to cardiovascular disease and a higher risk of strokes and heart attacks,” he said.

The increase in heart disease among young people is troubling considering the total number of heart attacks in the United States has declined overall, he says.

“This is especially disturbing because it follows many decades where heart disease was generally down in the population with modern treatments,” Chung said. “Some of the studies suggest a possible link to the COVID-19 pandemic, but there are likely multiple risk factors at play.”

Like Suradi, Chung lists genetics as a risk factor, Chung says.

“Genetics definitely plays a role and in some cases may be the main factor in young people who develop heart disease,” he said. “There are some diseases that are clearly linked with certain genes.”

Familial hypercholesterolemia, where a patient’s cholesterol levels can be sky-high and cause early coronary disease or strokes, is one of these.

“Because cholesterol is not usually tested in people at such a young age, this might not be recognized in a patient until they’ve had a heart attack,” Chung said. “There are also genetic mutations that can cause early heart failure. In some cases, we can see this occurring due to genetics even without a strong family history.”

A new genetic test, known as a polygenic risk score, allows physicians to look at thousands of genetic variants in a patient. Each variant can contribute to heart disease risk, but when stacked together, they may put a person at a much higher risk, Mutharasan says.

“With cholesterol, it adds complexion or flavor to this discussion about risk,” he said. “But the other risk factors are just as important. Someone with a really strong family history, but who doesn’t have other risk factors, might benefit from this tool.”

Chung says it’s still too early to know the usefulness of polygenic risk scores in medical practice.

“While knowing your risk profile for heart disease can be helpful in encouraging lifestyle changes, whether these risk factors should result in additional testing or treatment remains to be seen,” he said.

So how can young people reduce their risks of heart issues? Chung says it’s critical to start making lifestyle changes now.

“People who have a strong family history or other risk factors for heart disease should make the tried and true lifestyle choices that we have recommended for years — exercise and diet,” he said.

Chung recommends 2½ hours of exercise per week, which can be divided into five days of 30 minutes.

“The exercise should get your heart rate up,” he said. “Running or biking is much better than just walking.”

Diet should be balanced and include vegetables and fruits, he said.

“Any carb-based foods like bread and pasta should be whole grain,” Chung said. “The less processed foods, fast food and high-sodium foods, the better.”

Suradi advises separating preventive medicine in young people into categories.

“The young patients who develop traditional cardiovascular risk factors such as obesity or high blood pressure should see their doctors and establish a plan to change the multiple lifestyle factors that cause these issues, such as dietary changes and increasing physical activity,” he said.

However, lifestyle modifications alone aren’t always enough, he says.

“For this, there are a number of new safe and effective medications that are available to help this process,” Suradi said.

Suradi recommends that young athletes undergo health screening processes, including physicals and further testing, if warranted.

“If there is a family medical history of a significant cardiac condition, the best option is to discuss the risks with your doctor to evaluate the need for more testing,” he said.