A new study published in the Journal of the American Heart Association has found that heart attack deaths increased significantly among adults younger than age 55 between 2011 and 2022, with women experiencing higher mortality rates than men. The research, analyzing nearly 1 million hospitalizations, indicates that improving risk assessments to include nontraditional factors could help reduce these deaths, particularly among younger women.
Researchers analyzed health data from the National Inpatient Sample, a nationally representative database, focusing on adults ages 18-54 hospitalized with a first severe heart attack. Among 945,977 first-time hospitalizations, approximately 40% were for ST-segment elevation myocardial infarction (STEMI), the more severe form caused by complete coronary artery blockage, while over 62% were for non-STEMI (NSTEMI), resulting from partial blockage. The study revealed an absolute 1.2% increase in in-hospital deaths for STEMI patients during the study period, while NSTEMI death rates remained unchanged.
Women faced substantially higher risks, with 3.1% dying in the hospital from first-time STEMI compared to 2.6% of men, and 1% dying from NSTEMI compared to less than 1% of men. Despite similar rates of in-hospital complications, women received fewer cardiovascular procedures to identify and treat the causes of their heart attacks. The findings challenge previous assumptions that heart attack deaths were plateauing or decreasing, as earlier declines appear to have been driven largely by older adults and men.
Perhaps most significantly, the research identified that nontraditional risk factors—including low income, kidney disease, and non-tobacco drug use—were more strongly linked to heart attack deaths than traditional factors like high blood pressure or high cholesterol. Women had a higher prevalence of these nontraditional risk factors, with low income being the most prevalent for both heart attack subtypes. Among STEMI patients, nearly 35% of women were in the lowest income level compared to 29% of men, while among NSTEMI patients, about 38% of women had low income compared to 32% of men.
"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," said Dr. Mohan Satish, the study's lead author and a clinical cardiovascular disease fellow at New York Presbyterian/Weill Cornell Medical Center. The research was published in a Go Red for Women spotlight issue of the Journal of the American Heart Association, an open access, peer-reviewed journal available at https://www.ahajournals.org/journal/jaha.
The study's implications extend beyond clinical practice to public health policy, suggesting that socioeconomic factors and systemic healthcare disparities may contribute significantly to heart attack mortality among younger adults. With cardiovascular disease remaining the leading cause of death in the United States, these findings highlight the need for more comprehensive risk assessment approaches that address both medical and social determinants of health. Future research should examine how nontraditional risk factors interact with traditional ones and develop targeted interventions for vulnerable populations.
