Matias Escobar was in the middle of a triathlon when his heart stopped.
He was 38 years old. A runner for over two decades. He had completed Ironman races. His cholesterol was normal. His blood pressure was normal. He didn’t smoke. He barely drank. He had just passed a pre-race physical with zero flags. By every traditional measure, this man was the picture of cardiovascular health.
And then, during the final leg of the New York City Triathlon, he collapsed. His heart stopped. Paramedics performed CPR for twelve minutes before getting a pulse back. He spent days in a hospital coma. Surgeons placed a stent in his coronary artery.
He is one of fewer than 2% of people who survive what happened to him.
The doctors who treated Escobar at Mount Sinai called it a STEMI — an ST-elevated myocardial infarction, the most severe type of heart attack. They also called it something else: part of a growing trend that is quietly alarming cardiologists across the United States.
📺 Watch: Doctors at Mount Sinai Sound the Alarm
TODAY / NBC News — May 2024 | Featuring Dr. Deepak Bhatt, Director, Mount Sinai Fuster Heart Hospital
Something Is Shifting — and Doctors Can’t Fully Explain It
Here’s the number that stops cardiologists cold: between 10 and 20 percent of people who come into the ER with a heart attack have no obvious traditional cardiovascular risk factors at all.
None. No high cholesterol, no high blood pressure, no diabetes, no family history, no smoking. The medical community has even coined a term for this group: SMuRF-less patients — those who lack Standard Modifiable Cardiovascular Risk Factors.
And that group is growing.
Dr. Deepak Bhatt, director of the Mount Sinai Fuster Heart Hospital in New York, has been tracking patients like Escobar in an active research program aimed at finding what the traditional checklist is missing. “There are definitely more younger people coming in with heart attacks,” Bhatt told NBC’s TODAY. “There’s data to back that up. What’s driving that is more controversial.”
Meanwhile, at Cedars-Sinai in Los Angeles, researchers found that heart attacks in adults aged 18 to 44 have increased by more than 66% since 2019. The 25-to-44 age group saw the sharpest spike during the pandemic years — a nearly 30% jump in heart attack deaths in 2020 and 2021 alone compared to what models predicted.
And at Duke University, a 2024 study found that heart failure deaths — across all age groups — rose from 82 per 100,000 people in 2012 to 106 per 100,000 in 2021. The steepest climb? Adults under 45, who saw a dramatic increase over that nine-year period.
These aren’t fringe statistics. These are peer-reviewed findings from some of the most respected medical institutions in the country.
What’s Actually Driving This
This is the honest answer: no one has a single clean explanation. It’s likely several things happening at once, and the research is still catching up to the reality showing up in emergency rooms.
The hidden risk factors nobody’s checking for
One of the more uncomfortable findings from the Mount Sinai research is that traditional risk factors may be present in young adults — they’re just not being caught. Young, healthy-seeming people typically don’t get their cholesterol or blood pressure checked regularly. So elevated numbers that would trigger intervention in a 55-year-old go undetected in a 32-year-old until something goes wrong.
Dr. Bhatt also points to a set of behaviors and characteristics that are increasingly relevant but not yet embedded in standard screening: marijuana use, cocaine use, and a larger waist circumference — even in people who otherwise appear fit and active. These don’t show up on a standard pre-visit checklist, but the evidence linking them to cardiac risk is building.
The COVID-19 factor
This one is hard to ignore. The Cedars-Sinai research found the spike in young adult heart attacks held true even for those without prior risk factors — and the timing overlapped directly with the pandemic. Physician-scientists believe the body’s intense inflammatory response to COVID-19 infection may have damaged cardiovascular tissue in ways that don’t always show up immediately.
“Young people are obviously not really supposed to die of a heart attack,” said Dr. Susan Cheng, a Cedars-Sinai cardiologist who led the study. “They’re not really supposed to have heart attacks at all.”
Mount Sinai’s cardiology team echoed this — noting that the rise in heart failure deaths coinciding with COVID could reflect infection-related inflammation compounded by the economic and healthcare access disruptions of the pandemic years.
The diabesity epidemic
Dr. C. Noel Bairey Merz, director of the Barbra Streisand Women’s Heart Center at Cedars-Sinai, uses the term “diabesity” — the convergence of rising obesity and diabetes rates — to describe one of the biggest structural contributors. Diabetes, she notes, is a significantly stronger risk factor for cardiovascular events in women than in men, though researchers are still working out exactly why.
She also flags a trend that’s easy to miss: college-educated young women increasingly using smoking and vaping for weight management. “There is no safe tobacco or cannabis,” she said flatly.
Stress, sleep, and the lifestyle we keep dismissing
Chronic stress, poor sleep, ultra-processed diets, and sedentary lifestyles are each, independently, associated with elevated cardiovascular risk. Put them together — which is the reality for most working adults in their 30s and 40s — and the cumulative effect on arterial health is meaningful. These aren’t soft lifestyle factors. They have measurable physiological consequences that accumulate quietly over years.
Women Are Getting Hit Differently
This part deserves its own paragraph, because it’s one of the more underreported aspects of this trend.
Heart attacks in women aged 35 to 54 are rising at a faster rate than in their male counterparts. The symptoms women experience are also frequently different — and more frequently missed, both by patients and by clinicians. Where men typically report crushing chest pain, women are more likely to experience jaw pain, back pain, nausea, extreme fatigue, or shortness of breath without significant chest discomfort.
Women are also less likely to be taken seriously when they present with these symptoms. This isn’t a conspiracy — it’s a documented pattern in emergency medicine research, and it’s one reason heart attacks in young women go undiagnosed or misdiagnosed more often than in young men.
If you’re a woman and something feels wrong with your body — especially if it involves your chest, jaw, back, left arm, or comes with unexplained fatigue and sweating — trust that feeling and push for answers.
What You Can Actually Do
This isn’t meant to scare you into a spiral. It’s meant to get you paying attention earlier than most people do. Here’s where to start:
Know your numbers — right now, not when you’re older. Blood pressure, cholesterol (full lipid panel), blood sugar, and waist circumference. If you’re in your 20s or 30s and you’ve never had these checked, you’re flying blind. Get a baseline. Ask your doctor for one.
Tell your doctor everything. If you smoke marijuana, use recreational drugs, vape, or have noticed changes in your stamina or energy, say so. Your doctor cannot factor in what they don’t know.
Take your family history seriously. Even if your parents never had a heart attack, ask about grandparents, aunts, uncles. Genetic cardiovascular risk doesn’t always skip generations neatly, and it’s more relevant than most young people realize.
Learn the warning signs — and don’t dismiss them. Classic symptoms: chest pain or pressure, pain radiating to the arm, jaw, or back, shortness of breath, cold sweats, nausea, and lightheadedness. Atypical symptoms (more common in women): extreme unexplained fatigue, nausea without chest pain, back or jaw pain that feels disconnected from anything obvious. If these show up during or after physical activity, that’s especially worth flagging.
Move consistently, not just intensely. The American Heart Association recommends at least 150 minutes per week of moderate-intensity aerobic activity. Ironically, the Escobar story isn’t a reason to stop exercising — it’s a reason to get cleared before pushing into extreme endurance territory. Marathon training and triathlon prep put real demands on the cardiovascular system; they’re not inherently dangerous, but they’re better done with a current cardiac workup.
Manage what you can manage. Sleep. Chronic stress. Your diet. These feel like soft targets but they’re not. Inflammation — driven in large part by poor sleep, chronic stress, and ultra-processed food — is increasingly understood as a core mechanism behind premature cardiovascular disease.
The Bottom Line
The idea that heart attacks are something that happens to older people — people who smoke, people who are overweight, people with bad labs — is not wrong exactly. But it’s dangerously incomplete.
Ten to twenty percent of people showing up in cardiac units right now don’t fit that profile at all. They’re runners. They’re in their 30s. They passed their last physical. And something still went wrong.
The medical community is working to understand it. Researchers at Mount Sinai, Cedars-Sinai, Duke, and elsewhere are actively studying what the traditional risk model is missing. That work takes time.
In the meantime, the best thing you can do is refuse to assume you’re exempt. Know your numbers. Know your symptoms. Get checked. Pay attention to your body in the way that you probably would if you knew this was possible.
Because clearly, it is.
Sources: TODAY / NBC News, Mount Sinai Fuster Heart Hospital, Cedars-Sinai Medical Center, University of Miami Health, STAT News, Duke University cardiovascular research, American Heart Association, Yale Climate Connections.
💬 READER’S AREA
Has someone you know had a heart attack young and healthy? Or have you had your heart checked recently? Share in the comments — this conversation could save someone’s life.