Smoking, obesity, high blood pressure, diabetes and obstructive pulmonary disease were among the risk factors lowering the average age of patients treated for the most severe and deadly type of heart attack between 1995 and 2014 at the famed Cleveland Clinic, according to a new report issued by the American Cardiology College (ACC). This type of heart attack, called STEMI or ST-elevation myocardial infarction, occurs when one of the heart’s main arteries becomes completely blocked by plaque, stopping the flow of blood. Immediate medical attention can increase the chances of survival, but STEMI carries a high risk of death and disability.

During the 10-year study, the average age of STEMI patients decreased from 64 to 60, and the prevalence of obesity increased from 31% to 40%. While smoking rates among the general U.S. population dropped during the same period, the rate among these STEMI patients rose from 28% to 46%. 

An unhealthy lifestyle seems to cut across the different risk factors, with the study revealing a significant increase—from 65% to 85%—in the proportion of patients who had three or more major risk factors. 

“On the whole, the medical community has done an outstanding job of improving treatments for heart disease, but this study shows that we have to do better on the prevention side,” Samir Kapadia, MD, professor of medicine and section head for interventional cardiology at Cleveland Clinic and the study’s primary investigator, told ACC. “When people come for routine checkups, it is critical to stress the importance of reducing risk factors through weight reduction, eating a healthy diet and being physically active.”