I’m a cardiologist – and these are the key four ways to spot you might be unknowingly heading for a heart attack or stroke… as cases rise in under 50s

If an elderly man starts clutching his chest in agony, sweating heavily, and gasping for air, everyone knows he’s likely having a heart attack.

However, with cases rising among working aged adults, experts warn that there are a number of subtle warning signs that are often overlooked, particularly by young people, that could signal that they’re at risk of suffering the same fate.

Last week survey data from the British Heart Foundation revealed the extent of the public’s misconceptions on cardiovascular disease.

The research found that one in five people wrongly think only over-60s are at risk, while 40 per cent believe that symptoms come on suddenly, like in movies.

This comes as cardiovascular deaths have risen by nearly a fifth in working-age adults this decade.

Cases of heart attacks, heart failure and strokes among the under-75s had tumbled since the 1960s thanks to plummeting smoking rates, advanced surgical techniques and breakthroughs such as stents and statins.

But now obesity, diabetes and undiagnosed high blood pressure are reversing six decades of progress.

The UK’s heart health has declined more quickly at the start of the 2020s than in any other decade for more than 50 years, with deaths from cardiovascular disease in working-age adults rising by almost 18 per cent between 2019 and 2023, from 18,693 to 21,975.

A study published earlier this week by researchers at Northwestern University in Chicago and Yonsei University in Seoul, which analysed data from over 9 million people, found that more than 99 per cent of patients had at least one major risk factor, long before their first cardiac emergency.

However, high blood pressure—also known as hypertension – was by far the most common culprit, hitting more than nine in ten of participants.

The findings overturn the widespread belief that heart disease can strike ‘out of the blue’, affecting people with no obvious health problems.

Experts say that there are a number of warning signs that if spotted can prevent the ‘silent killer’.

Common ones include breathlessness during household chores, unexplained chest pain as well as fatigue. 

‘Research has shown that around half of patients who present with heart attacks will have had no prior symptoms in the years or months before the event. Importantly, the vast majority of people will have undiagnosed risk factors before suffering from a major cardiac event,’ says Professor Rasha Al-Lamee.

‘As well as the commonly known risk factors, like diabetes and obesity, there are a number of markers in the body which may indicate that someone is heading towards a heart attack.

‘And it is incredibly important that patients have regular checks for their risk factors and are put on preventative medication if necessary.’

It’s also crucial to note that heart attacks often present differently in women than they do in men—quite often they do not even experience chest pain. 

Instead, they may experience shortness of breath, nausea, indigestion, upper abdominal pain, dizziness or passing out. 

Gum disease 

Bleeding gums is not just a sign of poor oral hygiene; it could be the first red flag for cardiovascular disease, warn experts.

One recent study funded by the British Heart Foundation found that those with gum disease had a 69 per cent higher chance of developing type 2 diabetes—the blood sugar control problem that dramatically increases the risk of heart attacks and stroke.

Studies also show that treating gum disease improves artery function around the heart and reduces overall inflammation in the body.

Scientists believe this link is caused by the oral microbiome – the trillions of bacteria that live in the mouth.

When this delicate balance is disturbed, harmful microbes thrive, leading to gum disease.

These bacteria can leak into the bloodstream, triggering widespread inflammation and damaging blood vessels.

Over time this process can accelerate the build-up of fatty deposits in arteries, raising the risk of heart disease and stroke.

‘We believe part of the link between gum and cardiovascular disease may be explained by the inflammation caused by the bacteria in the mouth,’ says Professor Al-Lamee.

‘However, there is not a defined cause and effect yet, and importantly people with gum disease often have other comorbidities and poor health that will mean that they are at risk of cardiovascular disease.’

Erectile dysfunction

Doctors say that trouble in the bedroom can sometimes be an early warning sign of trouble with the heart.

Erectile dysfunction is often caused by poor blood flow – the same problem that underpins heart disease.

In fact, the tiny arteries supplying the penis can become furred up and narrowed years before larger vessels around the heart show signs of strain.

That’s why men with ED are more likely to go on to develop heart problems. Experts now believe erectile difficulties should be seen not just as a private matter, but as a red flag for wider cardiovascular risk.

A major review of dozens of studies, published in 2020 by the British Journal of Urology, found that erectile dysfunction is a good indicator of heart health.

The researchers looked at data from hundreds of thousands of men and found that those with erectile dysfunction were far more likely to go on to develop serious heart problems – even when other risks such as smoking or high blood pressure were taken into account.

On average, men with ED had around a 50 per cent higher risk of coronary heart disease, stroke or dying from cardiovascular causes.

‘As the arteries in the penis are smaller than elsewhere in the body, blockages in these arteries that cause erectile dysfunction can be an initial warning sign of atherosclerosis (the fatty build up in the arteries) in other arteries in the body too.’

‘While snoring itself is not linked to heart disease, obstructive sleep apnoea is,’ says Professor Al-Lamee.

‘This is likely to be mainly because of its link to other metabolic conditions and obesity, so it should act as a warning sign of risk factors for cardiovascular disease.’

Snoring

Snoring may be more than just an annoyance to your partner, it could be sleep apnea, which is a warning sign of heart disease.

Sleep apnoea is a common sleep disorder with nearly one billion sufferers worldwide.

Its most common form, obstructive sleep apnoea (OSA), causes the walls of the throat to relax and narrow or close for a few seconds during sleep.

This triggers breathing pauses and loud snoring.

Up to 3.9 million people in the UK are estimated to have moderate or severe OSA, although it is considered to be under-diagnosed.

Not all snorers have sleep apnoea, but the two often go hand in hand, and the louder the snoring, the greater the chances of having it.

A 2022 review of studies, which included over 150,000 patients, found that snorers had a 28 per cent greater chance of developing conary artery disease than non snorers.

‘While snoring itself is not linked to heart disease, sleep apnea is,’ says Professor Al-Lamee.

‘This is because of its link to other metabolic conditions and obesity, so it should act as a warning sign if you are not already managing that condition.’

Cold hands and feet

Repeatedly having cold hands and feet could indicate high blood pressure.

This is because during cold weather your blood vessels constrict (vasoconstriction), which causes your blood pressure and heart rate to rise.

This means your heart has to work harder to pump blood around your body. The body will make sure blood flows to your vital organs such as brain, lungs, and kidneys first, which can leave your hands and feet feeling chilly.

Hands and feet can appear pale or bluish and feel numb and tingly. This is a normal response to the cold, but if your heart is not working as well as it should or you have poor circulation, your hands and feet may feel even colder than usual.

‘On their own this is not going to tell you if you are at risk of heart disease but in combination with other factors it may be an indication,’ says Professor Al-Lamee.