Heart disease and strokes have long been regarded as health threats lurking in the later chapters of life, but recent research and new medical guidelines are painting a much more urgent—and complex—picture. Not only are these cardiovascular events striking at younger ages, but a surprising number of seemingly healthy women are falling victim, even when they lack traditional risk factors. The convergence of two major studies and updated recommendations from leading health authorities is now prompting a rethink of how heart health is assessed and protected, especially for women and younger adults.
According to the Cardio Metabolic Institute, one in five heart attack patients is now under 40 years old—a statistic that would have raised eyebrows a generation ago. The situation appears particularly dire for women. As reported by JHEOR, women face a higher risk of dying from heart disease, including both heart attacks and strokes, than their male counterparts. This risk accelerates dramatically after menopause. Yet, even as awareness of these trends grows, many women with cardiac issues remain undiagnosed and untreated, largely because they don’t fit the standard profile of risk.
Traditionally, doctors have focused on four main culprits—hypertension, high cholesterol, diabetes, and smoking—collectively referred to as “standard modifiable risk factors,” or SMuRFs. But, as highlighted by The European Heart Journal, a growing number of women suffering heart attacks or strokes have none of these factors. These “SMuRF-less” women are often considered low-risk, but the statistics tell a different story. A recent study led by Dr. Paul Ridker of Mass General Brigham’s Heart and Vascular Institute, presented at the 2025 European Society of Cardiology Congress, suggests that inflammation may be the hidden danger putting these women at risk.
“Women who suffer from heart attacks and strokes yet have no standard modifiable risk factors are not identified by the risk equations doctors use in daily practice,” Dr. Ridker explained in a press release. “Yet our data clearly show that apparently healthy women who are inflamed are at substantial lifetime risk. We should be identifying these women in their 40s, at a time when they can initiate preventive care, not wait for the disease to establish itself in their 70s when it is often too late to make a real difference.”
The study assessed 12,530 healthy, SMuRF-less women over a remarkable 30-year period, tracking their cardiovascular health and outcomes. Participants underwent a blood test for high-sensitivity C-reactive protein (hsCRP), a marker of inflammation produced by the liver. Elevated hsCRP levels—specifically above 3 mg/L—flagged women as “inflamed” and at higher risk, even if they otherwise appeared healthy. Over the study’s three decades, 973 women experienced major cardiovascular events, including heart attacks and strokes.
The findings were striking: women with high hsCRP levels faced a 77% increased lifetime risk of coronary heart disease, a 52% increased risk of any major cardiovascular event, and a 39% increased risk of stroke compared to those with lower inflammation. These numbers are not just statistical curiosities—they represent thousands of lives upended by illness that might have been preventable with earlier detection and intervention.
The Mayo Clinic underscores the significance of hsCRP testing, noting that people with high levels are more likely to have another heart attack if they’ve already had one, but their risk drops when hsCRP returns to the typical range. Encouragingly, the study found that statins—commonly prescribed to lower cholesterol—can also reduce heart attack and stroke risk by 38% in SMuRF-less but inflamed individuals. “While those with inflammation should aggressively initiate lifestyle and behavioral preventive efforts, statin therapy could also play an important role in helping reduce risk among these individuals,” said Dr. Ridker.
Of course, the classic risk factors haven’t disappeared. The American Heart Association (AHA) introduced new blood pressure guidelines on September 4, 2025, responding to the alarming rise in hypertension among young people. Roughly 25% of adults aged 18 to 39 now have hypertension—defined as blood pressure above 130/80 mm Hg—and even some children and adolescents are affected. According to a 2024 CDC report, 47.7% of adults 18 and older had hypertension between 2020 and 2023, and about four in ten were unaware of their condition.
The AHA’s updated guidelines place renewed emphasis on prevention, urging earlier action and broader screening. One innovative tool is the PREVENT calculator, designed to estimate a person’s 10- and 30-year risk of cardiovascular disease based on variables like age, sex, blood pressure, cholesterol, and even zip code, which serves as a stand-in for social determinants of health.
Medication guidance has also evolved. The new recommendations include GLP-1 medications for some overweight or obese patients with high blood pressure, and address the management of hypertension before, during, and after pregnancy—a period when the condition can cause life-threatening complications. Dietary advice is another cornerstone: potassium-based salt substitutes are now recommended over traditional table salt, and adults are urged to limit sodium intake to less than 2,300 mg per day, aiming for an ideal of 1,500 mg. The DASH diet—rich in vegetables, fruits, whole grains, legumes, nuts, seeds, lean meats, fish, and non-tropical oils—remains the gold standard for heart health. Alcohol should be limited to no more than two drinks daily for men and one for women.
Stress management is also highlighted, with exercise, meditation, breathing control, and yoga all recommended. Maintaining a healthy weight and engaging in 75 to 150 minutes of cardio and weight training each week are essential lifestyle pillars. Yet, despite these efforts, hypertension remains a silent killer; it often causes no symptoms until a crisis hits. When blood pressure soars above 180/120 mm Hg—a hypertensive emergency—headaches, heart palpitations, and nosebleeds may appear, but by then, the risks are acute.
Men continue to have a higher prevalence of hypertension (50.8%) than women (44.6%), but the gap is closing, and prevalence among young adults is on the rise. The CDC has noted a nearly 15% increase in strokes among Americans under 45 since 2011, a trend attributed partly to rising blood pressure, but also to nationwide increases in obesity and drug addiction. The Cleveland Clinic lists recreational drug use, unhealthy diets, and sedentary lifestyles as major contributors to hypertension, though healthy and active individuals are not immune.
Awareness and treatment rates lag far behind what’s needed. Only about 27% of young adults with hypertension know they have it, compared to 74% of seniors, and just 14% of younger people are receiving treatment. Across all age groups, only 21% of people have their blood pressure controlled to a healthy level. High blood pressure was the primary or contributing cause of more than 685,000 deaths in the US in 2022 alone.
Recognizing the unique risks faced by women and younger adults, experts urge a more nuanced approach to prevention and treatment. Heart attacks in women often manifest differently than in men, with symptoms like upper body pain, shortness of breath, lightheadedness, cold sweats, fatigue, and nausea. Johns Hopkins Medicine recommends practical steps to lower risk: maintain a healthy weight, eat a heart-healthy diet, exercise regularly, limit alcohol, avoid long periods of sitting, manage stress, and stay on top of annual checkups and known risk factors.
The growing body of evidence is clear: heart health is not just a concern for the elderly or those with obvious risk factors. Inflammation, lifestyle, and even social determinants play a role, and early detection can be lifesaving. As guidelines evolve and research uncovers new threats, vigilance and proactive care have never been more important, especially for women and younger generations.
