If an older man clutches his chest in agony, most people would know he’s having a heart attack.
But with cases now rising in people under 50, cardiologists warn the real danger is the subtle symptoms many ignore.
Figures show deaths from heart attacks, strokes and heart failure in working-age adults have surged by nearly a fifth in just four years, reversing decades of progress. Hospital admissions are also climbing in people in their 30s and 40s.
A major study of nine million people published this week found that more than 99 per cent of patients had at least one risk factor long before their first cardiac emergency – most often high blood pressure.
So what are the unexpected signs that you might be heading for a heart attack or stroke?
Professor Rasha Al-Lamee, consultant cardiologist at Imperial College London, says the main red flags include breathlessness during everyday tasks, unexplained chest pain that comes and goes, and unusual fatigue.
Women, meanwhile, may not experience chest pain at all and are more likely to report nausea, indigestion, dizziness, upper abdominal pain or fainting.
‘Half of patients who present with heart attacks will have had no obvious symptoms, but almost all have undiagnosed risk factors,’ says Prof Al-Lamee.
NHS figures show that while most cardiac events still occur in older age, hospital admissions for heart attacks among people in their 30s and 40s have risen in recent years
Almost everyone who suffers a heart attack, stroke or heart failure experiences warning signs years before the event, according to landmark research
‘That’s why regular checks for blood pressure, cholesterol and diabetes are vital – and preventative medication when needed can save lives.’
And experts warn these are just the start of the warning signs everyone should know – with many more clues hidden in the body that most people would never think to link to their heart.
Why gum disease is a sign of heart risk
Bleeding gums are not just a sign of poor oral hygiene – they could be an early warning of cardiovascular disease, experts warn.
A British Heart Foundation-funded study found that people with gum disease were 69 per cent more likely to develop type 2 diabetes, which in turn raises the risk of heart attacks and strokes.
Other research shows that treating gum disease improves artery function and reduces overall inflammation in the body.
Scientists believe the link lies in the oral microbiome – the trillions of bacteria living in the mouth. When this balance is disturbed, harmful microbes flourish, triggering gum disease and fuelling wider health problems.
These bacteria can leak into the bloodstream, triggering widespread inflammation and damaging blood vessels.
Scientists believe this link is in maintaining the oral microbiome – the trillions of bacteria that live in the mouth
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 is a red flag
Trouble in the bedroom is often caused by poor blood flow – the same underlying problem behind heart attacks and strokes.
The tiny arteries that supply the penis can become furred up and narrowed years before larger vessels around the heart show strain.
As a result, men with erectile difficulties are significantly more likely to go on to develop serious cardiovascular problems. Experts say ED should no longer be seen purely as a private matter but as an early warning sign of heart risk.
A major review of dozens of studies, published in 2020 in the British Journal of Urology, analysed data from hundreds of thousands of men and found that those with erectile dysfunction were far more likely to suffer heart disease – even after accounting for factors such as smoking and high blood pressure.
On average, men with erectile dysfunction have around a 50 per cent higher risk of developing coronary heart disease, suffering a stroke or dying from cardiovascular causes.
‘As the arteries in the penis are smaller than elsewhere in the body, blockages that cause erectile dysfunction can be an early warning sign of atherosclerosis – the fatty build-up in arteries – developing elsewhere too,’ says Professor Rasha Al-Lamee.
Why snoring isn’t just annoying
In many cases, loud snoring is caused by obstructive sleep apnoea (OSA), a common disorder in which the walls of the throat relax and briefly close during sleep, triggering pauses in breathing.
The condition is thought to affect up to 3.9million people in the UK, although many remain undiagnosed.
Not all snorers have sleep apnoea, but the two often go hand in hand – and the louder the snoring, the higher the risk.
A 2022 review of studies involving more than 150,000 patients found that snorers had a 28 per cent higher chance of developing coronary artery disease than non-snorers.
‘While snoring itself is not directly linked to heart disease, sleep apnoea is,’ says Professor Rasha Al-Lamee.
‘This is because of its connection with obesity and other metabolic conditions, so it should act as a warning sign if you are not already managing those risks.’
When chilly fingers mean heart strain
When temperatures drop, blood vessels naturally constrict, raising blood pressure and forcing the heart to work harder to pump blood around the body.
To protect vital organs such as the brain, lungs and kidneys, circulation to the extremities is reduced – leaving hands and feet pale, bluish, numb or tingling.
For most people this is a normal response, but if the heart is struggling or circulation is poor, the effect can be exaggerated.
‘On their own this won’t tell you if you are at risk of heart disease,’ says Professor Rasha Al-Lamee. ‘But in combination with other factors, it may be an indication.’
