September 29, 2025, 10:47 am | Read time: 5 minutes
Heart attacks in younger people? Unthinkable for many—yet it happens, and often there’s more to it than clogged arteries. A study with high scientific standards shows: Especially in women under 65, other, less known causes play a central role. They are often overlooked.
Women Suffer Heart Attacks Less Often Than Men Due to Clogged Vessels
Cardiovascular specialists from the world-renowned Mayo Clinic examined 1,474 actual heart attacks in people 65 and younger, diagnosed between 2003 and 2018 in Olmsted County, Minnesota.1 The goal of the medical team, including Claire E. Raphael, Yader Sandoval, and Joel D. Beachey, was to assign each heart attack to a clear primary cause. The researchers were convinced that causes beyond the classic artery calcification have been completely underestimated, especially those causes of heart attacks in women.
What they found was both unsurprising and very surprising: It turned out that artery calcification (atherothrombosis) was a risk factor for 75 percent of heart attacks in men. In women, artery calcification was the cause of less than half (47 percent) of heart attacks.
Cardiologist Claire Raphael explained in a Mayo Clinic press release: “This research sheds light on the causes of heart attacks that have been underestimated, particularly in women.” If the root cause of a heart attack is misunderstood, “it can lead to less effective treatments—or even harmful ones,” Raphael said.2
Underestimated Heart Attack Causes Beyond Artery Calcification
The researchers found that other factors significantly contributing to heart attacks include:
- spontaneous tears in the artery wall, where blood accumulates in the tears (called spontaneous coronary artery dissections, or SCADs)
- embolisms—blood clots from other parts of the body that are swept into the coronary arteries
- vasospasm—the sudden, cramp-like narrowing of a blood vessel
- heart attacks due to oxygen deficiency without vessel narrowing (the technical term is Secondary Supply-Demand Mismatch Infarction, or SSDMs)
Additionally, among the heart attacks studied were those without significant vessel narrowing and unclear cause (the technical term is MINOCA-U).
Particularly alarming: The doctors demonstrated that many spontaneous tears in the heart artery (SCADs) were initially mistakenly attributed to artery calcification (atherothrombosis)—55 percent of the time. This was especially true for women.
Also interesting: Why Heart Attacks Are More Often Fatal in the Morning Than Later in the Day
SCAD, SSDM, MINOCA & Co.–the Other Side of Heart Attacks
In the women studied with heart attacks, a SCAD was almost six times more likely to be the main cause of the event than in men. SSDMs were twice as likely to be the cause in women as in men. Vasospasm, embolisms, and heart attacks without a clear cause and without significant vessel narrowing (MINOCA-U) also occurred more frequently in women than in men.
These findings are alarming. Why? A spontaneous tear in the heart artery must be treated differently to artery calcification. If doctors misdiagnose the cause of a heart attack, they logically pursue the wrong approach in preventing the next attack.
The Mayo Clinic team urgently calls for “rethinking the approach to heart attacks in this patient group, especially in younger women,” says cardiologist Rajiv Gulati in the clinic’s statement. Doctors need to raise their awareness of conditions like SCAD, embolisms, and stress-related triggers, Gulati says. He also appeals to patients: They should seek answers “if something doesn’t feel right.”
Preventing Heart Attacks: These Blood Values Are Crucial
“Heart diseases, and especially circulatory disorders of the heart or heart attacks, are not a typical old man’s disease,” says Dr. med. Christopher Schneeweis, a specialist in internal medicine and cardiology. His advice: Every healthy person should have early checks:
* Do I have elevated cholesterol levels or a predisposition for it? (high ApoB-100, LDL cholesterol levels)
* Is my lipoprotein(a) level elevated?
* Do I have family events that occurred early?
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What the Study Results Mean for Women
The study makes it clear: A heart attack in those under 65 is not just a heart attack—and this is especially true for women. While in men, the classic artery calcification, caused by the deposition of fat, calcium, and connective tissue, is usually responsible and can lead to complete blockage in the worst case, in women, it is often other, less known mechanisms: e.g., spontaneous tears in the heart artery, vasospasm, embolisms, heart attacks due to oxygen deficiency without vessel narrowing.
What does this mean for women? An atypical EKG or only slightly elevated troponin levels should not be hastily dismissed as harmless. And: Risk factors like high blood pressure or diabetes were even more pronounced in women with artery calcification than in men.
Conclusion
Not every heart attack is due to calcified vessels. Especially not those in women. Spontaneous artery tears, vessel spasms, or oxygen deficiency situations play a central role, particularly in female patients. These findings should be incorporated into guidelines, education, and clinical practice, as they have profound implications for diagnosis, therapy, and follow-up care. A differentiated diagnosis can ultimately save lives—and improve long-term prognosis.