A new study published in the Journal of the American Heart Association reveals a concerning trend: heart attack deaths increased significantly among adults younger than 55 between 2011 and 2022, with women experiencing higher mortality rates than men. The research, analyzing nearly 1 million hospitalizations, found that after accounting for all assessed risk factors, deaths remained more strongly linked to nontraditional factors like low income, kidney disease, and non-tobacco drug use rather than traditional factors such as high blood pressure or high cholesterol.
According to the analysis of National Inpatient Sample data, in-hospital deaths for patients hospitalized with a first severe heart attack (STEMI) showed an absolute 1.2% increase. Women were more likely to die in the hospital from a first-time heart attack at 3.1% for STEMI and 1% for NSTEMI, compared to men at 2.6% for STEMI and less than 1% for NSTEMI. While women experienced similar rates of in-hospital complications compared to men, they received fewer cardiovascular procedures to identify and treat causes of their heart attack.
"We often think heart attacks are mainly an older person's problem; however, our findings indicate that younger adults, especially women, are at real risk," said Dr. Mohan Satish, the study's lead author and a clinical cardiovascular disease fellow at New York Presbyterian/Weill Cornell Medical Center. The findings challenge previous assumptions that heart attack deaths had plateaued or decreased, with Satish noting that "that decline appears to have been driven largely by older adults and men."
The research highlights significant disparities in risk factor prevalence. Among STEMI hospitalizations, low income was the most prevalent nontraditional risk factor, affecting nearly 35% of women compared to nearly 29% of men. For NSTEMI cases, low income remained the most prevalent nontraditional factor for both sexes, though higher among women at about 38% compared to men at 32%. Younger women were the most likely to have nontraditional risk factors than males of the same age.
This research has important implications for clinical practice and public health. "Improving heart attack outcomes in adults younger than age 55, particularly women, will require earlier risk identification and consideration of nontraditional risk factors to improve treatment," Satish emphasized. The study suggests that current risk assessment models may be inadequate for younger populations, especially women, who present with different risk profiles than older adults or men.
The American Heart Association's Go Red for Women initiative, which has addressed awareness and clinical care gaps since 2004, highlights the importance of this research in understanding cardiovascular disease in women. Additional resources about heart attack warning signs and women's cardiovascular health are available through the American Heart Association at https://www.heart.org. The full study and related manuscripts from the JAHA Go Red for Women Spotlight issue can be accessed through the journal's website.
Future research needs to explore how nontraditional risk factors impart heart attack risk along with their impact on traditional risk factors. The authors acknowledge limitations including reliance on administrative hospital data and lack of long-term follow-up information after hospital discharge. However, the findings provide crucial evidence that improving risk assessments to include socioeconomic and other nontraditional factors could help reduce preventable deaths among younger adults experiencing heart attacks.
