Triathlete, 38, had a heart attack during a race with no warning. He's part of a growing trend

Twelve minutes. That's how long Matias Escobar lay on the ground without a pulse while paramedics performed CPR after his heart stopped last October. Moments before, the healthy 38-year-old had collapsed due to a heart attack while running the final leg of the New York City Triathlon.

Escobar suffered an ST-elevated myocardial infarction (STEMI) — the deadliest type of heart attack. "It’s called the widow maker. ... They told me that it’s less than 2% of people that survive," Escobar told TODAY in an exclusive interview aired Thursday, May 30.

Against the odds, Escobar survived. After spending several days in the hospital in a coma and getting a stent placed in his coronary artery, Escobar made a dramatic recovery. But the near-fatal heart attack left the healthy triathlete and his doctors wondering what happened — and what signs could they have missed?

Escobar had been a runner for over two decades and competed in many triathlon and Ironman races. At the time of his heart attack in 2023, Escobar described himself as the epitome of health.

The New York City resident ate a healthy diet, had no stress or anxiety, didn't smoke and rarely drank. A pre-race checkup revealed he had normal blood pressure and cholesterol levels.

In fact, Escobar had no obvious risk factors at all. His heart attack was unexpected and unexplained.

More young people having heart attacks with fewer warning signs

Doctors say Escobar is part of a growing trend of younger, seemingly healthy adults having sudden cardiac events.

"In general, about 10-20% of people that come in with heart attacks don’t have any obvious, traditional cardiovascular risk factors,” Dr. Deepak Bhatt, director of the Mount Sinai Fuster Heart Hospital, told TODAY in an interview.

The conventional risk factors for a heart attack include high blood pressure, high blood sugar or diabetes, high cholesterol, being overweight or obese, and smoking, said Bhatt.

These are also known standard modifiable risk factors, or “SMuRFs," which account for about 80% of heart attacks, Bhatt explained.

But research has shown there's an increasing number of young, seemingly healthy and SMuRF-less heart attack patients.

Now, Bhatt and a group of doctors at Mount Sinai are tracking patients like Escobar to figure out whether there are other risk factors that are being missed or different ways of thinking about heart attacks.

“There are definitely more younger people coming in with heart attacks. There’s data to back that up. What’s driving that is more controversial,” said Bhatt.

One possible reason for the rise in SMuRF-less heart attacks is that these classic risk factors are not being identified in younger patients. For example, people who are young and otherwise healthy may not get their cholesterol or blood pressure routinely checked.

Another possible reason is that doctors are not considering other behaviors or qualities that can increase the risk of heart attacks because they aren't traditionally thought of as risk factors, Bhatt noted.

These include smoking marijuana, using cocaine and a larger waist circumference. "It probably has to do with the obesity epidemic, and I hate to say it, but there's more substance abuse these days," said Bhatt.

Another potential clue is inflammation, which seems to be a common denominator in many SMuRF-less patients.

“What causes most heart attacks are plaque in the artery, and inflammation (can) anger the plaque to act up, then it ruptures, which can form a blood clot. ... If it’s a big enough clot, it will obstruct the artery,” Bhatt explained.

"Inflammation can be a good thing. ... If you have an infection, you want to have a fever and want inflammation to clear the infection," he continued. "I’m talking about lower, more smoldering inflammation, that seems to predispose to heart attack (and) also stroke risk. There are markers that look for that.”

Searching for clues in one patient's story

In the hospital, Escobar’s doctors dug deeper to see what they could’ve missed and “to understand why a young guy like him, so healthy and athletic, would come in a dire condition,” Dr. Serdar Farhan, an interventional cardiologist at Mount Sinai Hospital and Escobar’s doctor, told TODAY.

In Escobar’s case, he not only had a heart attack, but the deadliest type. A STEMI causes a total blockage of the main artery supplying oxygen-rich blood to the heart muscle, per the Cleveland Clinic. "This (artery) supplies around 60-70%. ... That’s why they call (it) a widow maker,” said Farhan.

As Escobar described it: “It’s immediate, you don’t have any type of warning, (like) ‘Oh, my arm is starting to hurt, I have chest pain, or I’m feeling dizzy’ — it’s just sudden. It’s a sudden death.”

Upon investigating, doctors discovered Escobar had signs of inflammation, including an elevated C-reactive protein, which is secreted by the liver in response to infections or inflammation. However, it's not clear if this marker was high before his heart attack and for how long; it may've only increased afterward, which happens in some patients, Farhan explained.

The cause of inflammation in otherwise healthy patients like Escobar is not yet clear.

Doctors also discovered the triathlete previously had elevated cholesterol levels when he was younger.

"The cardiologist back then didn’t define it as a risk. It was a data point that I needed to bring down, but I wasn’t diagnosed with anything," says Escobar, adding that he was able to lower his cholesterol naturally with his diet.

At the time of his heart attack, Escobar's cholesterol levels were normal.

“Was it a risk? It matters what your cholesterol is today of course, but also how long it was high before and how high — that determines how much plaque (you have), even if it’s been well-controlled,” Bhatt said.

High cholesterol can cause fatty deposits to build up in the blood vessels, which an break off and cause a clot, leading to a heart attack, according to the Mayo Clinic.

"(They told me) it happens to athletes, if (you have) any cholesterol in your veins, it doesn’t matter how healthy you are," Escobar noted.

Reducing heart attack risk in young people

The experts say it's important for both patients and doctors to be aware of the potential risk factors for heart attacks and get routine checkups.

"I think that’s the most important message — know what the risk factors are and know your numbers. Everyone should know their blood sugar, blood pressure, waist circumference and bad (LDL) cholesterol. Those are key vital signs," said Bhatt.

People can reduce their risk of heart disease by eating a healthy diet full of fresh fruits, vegetables, whole grains and limiting red meat. Exercising for at least 30 minutes daily, getting enough sleep, and managing stress are also important, Bhatt emphasized.

The team of researchers at Mount Sinai is currently working on a project to investigate trends in SMURF-less patients. As doctors become more aware of cases like Escobar’s and gather more information, they hope to have a better understanding of what are considered “risk factors” in order to save more young lives.

Today, Escobar is recovering well. The husband and father of a 2-year-old sticks to a vegan diet and remains active. As for his next race, he's already preparing for the New York Triathlon.

"I (thought) a lot about this. Initially, I didn’t want to do the same race that killed me, basically, but I think I have to," says Escobar, adding that he won't let fear stop him.

This article was originally published on TODAY.com