Heart attack deaths increase in young adults, especially women

A new study found that heart attack deaths were up among younger adults with women more likely than men to die after a first heart attack. According to new research published today in a Go Red for Women spotlight issue of the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association, death rates rose by a 1.2% absolute increase among adults younger than age 55, who were hospitalized between 2011 and 2022 with a first severe heart attack.

Since 2004, the American Heart Association's initiative, Go Red for Women, has addressed the awareness and clinical care gaps of women's greatest health threat: cardiovascular disease. The JAHA Go Red Spotlight issue highlights nearly a dozen manuscripts underscoring cardiovascular disease in women.

In an analysis of nearly 1 million hospitalizations between 2011-2022 of U.S. adults ages 18-54, women had a higher rate of death in the hospital from a severe form of heart attack and from a less severe subtype compared to men.

The findings were surprising and concerning, said Mohan Satish, M.D., the study's lead author.

"U.S. heart attack deaths appeared to have plateaued or decreased, based on observational studies that extended into 2010. However, that decline appears to have been driven largely by older adults and men," said Satish, a clinical cardiovascular disease fellow and T32 postdoctoral fellow at New York Presbyterian/Weill Cornell Medical Center in New York City. "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."

Researchers compared data for two heart attack subtypes: ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). ST-segment elevation refers to a segment on an electrocardiogram tracing. STEMI is a more severe form of heart attack caused by a complete blockage of a coronary artery. NSTEMI is a less severe form caused by partial blockage of a coronary artery.

Key findings of the analysis include:

• Overall, after considering both hospital and patient characteristics, in-hospital deaths increased significantly among patients hospitalized with a first STEMI, with an absolute 1.2% increase. Rates for NSTEMI were unchanged.
• Women were more likely to die in the hospital from a first-time heart attack at 3.1% for those with 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.
• Younger women were the most likely to have nontraditional risk factors than males of the same age.
• Regardless of sex, after considering all risk factors assessed, more nontraditional risk factors for heart attack, such as low-income, kidney disease, or non-tobacco drug use, were strongly linked to death in the hospital from a heart attack compared to traditional risk factors.

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. Future studies need to consider how nontraditional risk factors impart heart attack risk along with their impact on traditional risk factors."

Mohan Satish, M.D., study's lead author

The authors acknowledge several limitations with this research, including reliance on administrative hospital data, which could have incorrect diagnoses and/or treatment codes. In addition, there was no long-term follow-up information after hospital discharge

Study details, background and design:

• Researchers analyzed health data of adults ages 18-54, from 2011 to 2022, from the National Inpatient Sample, a nationally representative database that includes all health insurance claims regardless of payer, including Medicare, Medicaid or private insurance.
• Among 945,977 first-time hospitalizations, nearly 40% (more than 356,000) were for patients with STEMI and more than 62% (nearly 600,000) were NSTEMI.
• Among all STEMI hospitalizations: 77.2% were in men; tobacco use was the most prevalent traditional risk factor; and low income was the most prevalent nontraditional risk factor. About 65% of women used tobacco compared to 61% of men, and nearly 35% of the women were in the lowest income level compared to nearly 29% of men.
• Among the NSTEMI group: 66.2% were men; high blood pressure was the most prevalent traditional risk factor in nearly 70% of men and 69% of women; low income was the most prevalent nontraditional risk factor for both sexes, though higher among women at about 38% compared to men at 32%.
• For both subtypes of heart attack, a higher proportion of men and women were white adults (69.6% in STEMI and 61.7% in NSTEMI) compared to people from other ethnic and racial groups.