A new study published in a Go Red for Women spotlight issue of the Journal of the American Heart Association found that heart attack deaths increased significantly among adults younger than age 55 between 2011 and 2022. The analysis of nearly 1 million hospitalizations showed women had higher mortality rates than men for both severe and less severe heart attack subtypes.
Researchers analyzed data from the National Inpatient Sample, a nationally representative database, examining 945,977 first-time hospitalizations. Among these, 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, while NSTEMI death rates remained unchanged.
Women faced significantly higher mortality rates, with 3.1% dying from STEMI and 1% from NSTEMI, compared to 2.6% and less than 1% respectively for men. Despite similar complication rates, women received fewer cardiovascular procedures to identify and treat heart attack causes. Lead author Mohan Satish, M.D., noted that while heart attack deaths appeared to have plateaued or decreased in older adults and men, younger adults, especially women, are at real risk.
The research identified nontraditional risk factors as strongly linked to in-hospital deaths. After accounting for all assessed factors, low income, kidney disease, and non-tobacco drug use were more strongly associated with mortality than traditional factors like high blood pressure or high cholesterol. Women had a higher prevalence of these nontraditional risk factors, with nearly 35% of female STEMI patients in the lowest income level compared to 29% of men. For NSTEMI, about 38% of women were low-income versus 32% of men.
Satish emphasized that improving outcomes for adults under 55, particularly women, requires earlier risk identification and consideration of nontraditional factors. The findings suggest current risk assessment models may be inadequate for younger populations. Future studies need to examine how nontraditional factors interact with traditional risk factors to impact heart attack risk.
The American Heart Association's Go Red for Women initiative, active since 2004, addresses awareness and clinical care gaps for cardiovascular disease in women. The JAHA Go Red Spotlight issue features nearly a dozen manuscripts on cardiovascular disease in women. Additional information about heart attack warning signs is available through American Heart Association health information.
Study limitations include reliance on administrative hospital data, which may contain incorrect diagnoses or treatment codes, and lack of long-term follow-up after hospital discharge. The research highlights the need for healthcare systems to adapt prevention and treatment strategies for younger adults, particularly women, by incorporating socioeconomic and other nontraditional factors into risk assessment protocols.
