Heart disease: decades in the making

by Carolyn Thomas      @HeartSisters  

I was surprised to learn after surviving my own heart attack that cardiac events like mine may take 20-30 years to actually show up. In other words, I didn’t have a heart attack because I ate a piece of bacon or had a stressful day at work. I had a heart attack because something – likely decades earlier – had damaged the delicate endothelial cells lining my coronary arteries.          .      .  .    .  

When I tell this to the women in my Heart-Smart Women audiences, many  want to know how to tell if they too might be at specific cardiac risk – so that they don’t end up with a heart attack.

My stock answer (after the standard “I’m-Not-A-Doctor” disclaimer) is that there is simply no downside to living as if we knew with 100% certainty that we’re at very high risk for cardiovascular disease. Even without having any risk factors, we already know that quitting smoking, exercising your body, eating healthier and learning to manage stress are good ways to live life.

This is an important consideration when talking about cardiac risk factors.

Remember that a known risk factor is NOT a death sentence – and we shouldn’t embrace lifestyle changes just to lower risk of a future disease that may or may not ever happen (behaviour scientists call this an avoidance goal) but because doing so makes us feel, sleep, look and function better (that’s an approach goal).  See also:  Why don’t patients listen to doctors’ heart-healthy advice?

Meanwhile, Harvard University experts describe how early the progress of cardiovascular disease can begin: 

“Heart attacks are swift, occurring in a matter of minutes. But atherosclerosis itself is slow, developing over years — and it can often begin in childhood.”

One study, for example reported that autopsies performed on casualties of the Korean War revealed coronary artery involvement in over 77 per cent of the hearts studied, all in soldiers under the age of 30.(1)

Even pre-teens can begin to show early signs of heart disease, according to the Cleveland Clinic:

“Coronary artery disease starts when you are very young. Before your teen years, the blood vessel walls start to show streaks of fat.

“As you get older, the streaks build up, causing minor damage to your blood vessel walls. With time, other substances that move through your blood stream, such as inflammatory cells, cellular waste products, proteins and calcium, stick to the vessel walls. These things combine with the fat to form plaque.”

We know now that younger women who experience pregnancy complications – as I did with my preeclampsia diagnosis – are also at significantly higher risk for developing serious heart disease, often many years after giving birth.  See also: Pregnancy complications strongly linked to heart disease

Obstetrician/researcher Dr. Graeme Smith at Queen’s University describes pregnancy as “the ultimate cardiac stress test”

“Pregnancy is a window of opportunity to screen women for health risks to ensure health preservation and heart disease prevention.”

Dr. Smith reminds women that pregnancy complications may be some of the earliest identifiable heart disease risk indicators available. It was only in 2011 that the American Heart Association released updated guidelines for preventing cardiovascular disease in women, including for the first time new warnings that high-risk women who have experienced pregnancy complications should have those factors taken into account when their heart disease risks are evaluated.

Yet to date, no commonly used cardiac risk calculators used by physicians in daily practice ask anything about a woman’s history of pregnancy complications.

The niggling question still remains:  do pregnancy complications cause cardiovascular damage, or do they reveal underlying cardiovascular disease?

These important early warning signs include:

  • preeclampsia
  • gestational hypertension
  • gestational diabetes
  • placental abruption
  • excessive weight gain
  • preterm birth
  • intrauterine growth restriction (full term birth/low birth weight)

If you are a woman who was born with a serious heart problem (a congenital heart defect), you may have been diagnosed and treated soon after birth. But according to the Mayo Clinic:

“Congenital heart defects are often not diagnosed until later in childhood or during adulthood.”

See also: When babies with congenital heart defects grow up

A 2019 study published in the British Medical Journal Heart (BMJ) reported some scary stats: despite an overall reduction in cardiovascular disease mortality, the rate of coronary heart disease diagnoses and mortality is actually on the rise in younger women aged 35-54 years.(2) 

One more scary stat:  if you have been treated for breast cancer, you should know that some cancer treatments are linked to a subsequent heart disease diagnosis – even years later.  The field of cardio-oncology is a relatively new medical specialty that focuses on preventive cardiac care for high-risk cancer patients. See also: When cancer treatment damages your heart

The American Heart Association neatly sums up this basic health advice for all young people:

“As early as childhood and adolescence, plaque can start accumulating in the arteries and later lead to clogged arteries. And not all people who have heart disease are senior citizens.”

Here’s the good news: cardiologists tell us that up to 80 per cent of heart disease risk factors are modifiable (which means that the choices we make in life can help to significantly lower many of those risks – like choosing to quit smoking, for example). 

So learn as much as you can about your own personal cardiac risks – and whether or not they are modifiable. And then, as the late U.S. tennis legend Arthur Ashe once advised:

“Start where you are. Use what you have. Do what you can!”

Image: congerdesign, Pixabay

  1.  Joseph A et al.  “Manifestations of coronary atherosclerosis in young trauma victims–an autopsy study.” J Am Coll Cardiol. 1993 August (2):459-67. doi: 10.1016/0735-1097(93)90050-b. PMID: 8335815.
  2. Young L, Cho L. “Unique cardiovascular risk factors in women.” BMJ

Q:  Did you experience an earlier medical diagnosis possibly linked to your current heart disease diagnosis?


NOTE FROM CAROLYN:   I wrote more on the origins of heart disease in my book, A Woman’s Guide to Living With Heart Disease (Johns Hopkins University Press), you can ask for it at your local bookshop, or order it online (paperback, hardcover or e-book) at Amazon.  Or order it directly from my publisher, Johns Hopkins University Press (use their code HTWN to save 20% off the list price).

See also:

-more Heart Sisters articles about young women and heart disease

17 thoughts on “Heart disease: decades in the making

  1. Ahhh, Carolyn. I was tested for lipids (cholesterol and the like) in medical school and was told my very high number was because I was on birth control pills, not to worry, and recheck at age 40.

    I built plaque all of that time, which led eventually to bypass surgery at the age of 56. I tell everyone that PREVENTION IS BETTER THAN TREATMENT. And I counsel all of my patients to get tested routinely.

    Liked by 1 person

    1. Hello Dr. Anne – you were doing just what any other young med student would have done, too: believed the person who told you “not to worry”.

      Prevention IS always better than treatment – as one of my doctors likes to say, you can TAKE time now, or you’ll have to MAKE time later.

      Take care, stay safe. . . ♥


  2. My heart disease was caused by drug I took for migraines. Sansert (Methysergide), that I took after looking it up in the CPS with my family doctor, caused changes to my heart that were known as a possible risk but not published in the Pharmaceutical Manual.

    I had to retire from work at age 46 in 1998 with Congestive Heart Failure and a troubling murmur. I was put on the “Urgent Outpatient” list for cardiac surgery.

    I had my mitral valve replaced in 2000, at which time the pathologist recognized the cause of the damage. My cardiologist (since retired) had never heard of this drug-induced damage. I discontinued the drug immediately. Since then I’ve successfully taken Topamax morning and night to stop the migraines.

    The damage continued. In 2011 I had my second open heart surgery when my tricuspid valve was replaced. At the time, my surgeon placed a pacemaker wire, because it usually goes through the tricuspid valve but that wouldn’t be possible now. He said I would need a pacemaker eventually and didn’t want anyone to open up my chest again.

    No pacemaker is needed so far, but I do have A-fib.

    Liked by 1 person

    1. Jenn, what a dramatic example of how, even with the best-informed discussions with healthcare professionals, controversial drugs like Sansert were prescribed that had such a life-altering impact on you – and at such a young age. My understanding is that this drug is no longer available in U.S. pharmacies anymore after being withdrawn by the manufacturer, Novartis due to risk benefit/ratio safety concerns – and the emergence of safer and more effective alternative drugs for migraine headaches – although Sansert may still be shipped from Canada.

      Good luck to you – take care and stay safe out there. . . ♥


  3. The problem with medical diagnoses, both early and late is that they are generally made when symptoms are so noticeable one goes to a doctor.

    In the field that I study and work in currently it is generally accepted that almost any symptomatic condition begins at least 7 years before the symptoms are noticed. It begins as tiny alterations in the vibrations of cell structures. These alterations are exacerbated by hereditary tendencies as well as current environmental factors like nutrition and exercise.

    So it seems all those things we were never taught as children are indeed, as you said, the most important. Nutritious food, sunshine, exercise and stress management.

    I believe our society is moving towards a more wellness centered existence and away from illness centered health care. It is just taking a REALLY long time!!

    Since I am 72 years old there are decades of alterations acting out right now in my body. And cutting out a weekly slice of bacon will not make much difference.

    But I am “starting where I am and doing what I can” which today is committing to purchase $100.00 per month Repatha to treat my LDL Cholesterol of 280 mg/dL.

    Blessings and Health to all of us! We are in this together!

    Liked by 1 person

    1. Hello Jill – I’ve heard cardiovascular disease described in the same fashion, i.e. that most heart patients are essentially presenting with late-stage heart disease, and that although our doctors can stent us or bypass us or zap our wonky electrical circuits, they simply cannot fix what damaged our hearts in the first place, oh-so-long ago. That’s why simply having already had a cardiac event is a key risk factor for having another one.

      Good luck with your Repatha – these PCSK9 inhibitor drugs can indeed be expensive, but have been found to lower that LDL cholesterol by a whopping 60%. I hope you enjoy comparably good results!

      Take care, stay safe. . . ♥


      1. I have Kaiser Medicare Advantage. On my bill it says the cost to Kaiser is $2,200.00 but my out of pocket under Medicare is $190 for first dose, then $100 per month.

        The problem is after a few months I will be in the Medicare gap… I’m not sure how high the price will go. I’m at a low enough income level that I can probably apply to Amgen the drug manufacturer and get it for no cost. I’ll be playing it by ear. My cardiac pharmacist says even if I can only afford it every other month it is still better than nothing as I can’t take statins.


  4. Part of the 20% (of heart disease risk factors) that are not modifiable would be the damage done by cortisol in the hearts of young children who are born into abusive families. We need preparatory school age education for future parents (all kids basically) on all aspects of the development of the brain in children.

    Liked by 2 people

    1. Hi Debra – thank you for raising this issue! Researchers call this history of abuse/neglect/household dysfunction “ACE” (adverse childhood events) and we know that the higher your ACE test score, the higher your risk for later health problems – ranging from headaches to cancer or heart disease.

      I wrote about this three years ago here, including a link to take the ACE quiz.

      What upset me most about this cardiac risk factor was that the focus of cardiology is rarely – if ever – on early childhood trauma and its lasting impact on our heart health.

      The ACE score is not in itself modifiable – we can’t turn back the clock or change our childhood history – but the interesting thing about this risk factor is that if we were lucky enough to have even one outside person (a teacher, a neighbour, a grandparent) who loved and supported us, ACE in itself isn’t necessarily as hopeless as originally feared.

      Take care, and stay safe. . . ♥

      Liked by 1 person

    2. Debra – Thank you for this. As a parent of two adopted children… the effects of excessive Stress hormones such as cortisol begin in the womb.

      An unwanted pregnancy, a fetus that is hated or malnourished physically and emotionally has lasting effects on the child once it is born.

      Both my children were adopted at birth and yet suffered from many neurological and mental health issues that most likely began before they were born.

      Liked by 2 people

      1. To Jill C: Yes that’s true it does start in the womb. My mother was physically and emotionally abusive to me and all my siblings, so each of us had a full dose of it in utero as well as post birth.

        I’m 62 and have dealt with those impacts all my life, which I used to think were all mental until I learned about ACEs. Several of us have circulation issues which is surprising because none of us smoke, or drink to excess, we watch our diet, exercise, in short do all the right things but still are having issues.

        Yes there is age and who knows what else, but it’s likely that the high ACE scores bear some blame.

        Liked by 1 person

  5. Great information, as always. Not that it is totally related, but my bicuspid aorta wasn’t found until the doctor heard a slight murmur during my exit physical from the Air Force, at age 38.

    I’m lucky because we did keep an eye on it and that is how we found the aneurysm. I’m just glad that I had already taken steps to be the healthiest I could be before surgery was required.

    I do believe that made a lot of difference in how I have fared afterwards.

    Liked by 1 person

    1. Who knew that the slight murmur would eventually mean the identification of an aneurysm?

      Such an important point about being the healthiest you can be BEFORE surgery! It just makes sense: recuperation can be more straightforward with fewer complications if the patient on the OR table is healthy to start off with.

      Take care, and stay safe. . . ♥

      Liked by 1 person

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