Heart attacks have become less life-threatening over time. A study out today, however, highlights a concerning reversal of fortune for younger Americans.
Researchers examined nationally representative data of hospitalized heart attack patients. Between 2011 and 2022, they found that the death rate of heart attacks rose among American adults under the age of 55, though with noticeable gender differences. The findings suggest that risk factors not traditionally associated with heart attacks could be increasing mortality in younger people, the researchers say, while younger women in particular might not always be getting optimal medical care.
“The main takeaway, especially for a younger patient, should be that the risk of a heart attack is not to be taken lightly, but that it goes beyond the classic things that they might have picked up from family members and others, like high cholesterol, high blood pressure, et cetera,” lead author Mohan Satish, a cardiology fellow at New York Presbyterian/Weill Cornell Medical Center, told Gizmodo.
A strange trend
Your odds of dying from a heart attack today are much lower than they were several decades ago, thanks to medical advances, better know-how to manage these cases, and a widespread decline in certain risk factors that worsen heart function, such as smoking. Just last year, a study calculated that the age-adjusted mortality rate from heart attacks, also known as an acute myocardial infarction, had declined by nearly 90% in the U.S. between 1970 and 2022.
This trend has continued into the 2020s, both in terms of reduced heart attack deaths and hospitalizations. But according to Satish, these improvements seem to have been largely concentrated among older people and men. So Satish and his team wanted to get a closer, more updated look at how younger Americans are faring after heart attacks, more specifically, their first heart attack.
They analyzed data from the National Inpatient Sample, the largest publicly available database of hospitalized patients collected from medical centers across the country (about 7 million hospital stays are recorded annually, amounting to roughly 20% of all hospitalizations each year). This allowed them to not only study a large group of people but also to distinguish between the two main types of heart attacks: an ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). STEMI heart attacks are caused by the complete blockage of a coronary artery and are more severe, whereas NSTEMI heart attacks are caused by a partial blockage and are milder.
In total, they studied around 950,000 hospitalizations. After accounting for both patient and hospital factors, the death rate from STEMI heart attacks among Americans ages 18 to 55 climbed between 2011 and 2022, with an absolute increase of 1.2%. The death rate of NSTEMI heart attacks stayed level, however. The rise in STEMI deaths was larger in younger men, but younger women remained more likely to die from such heart attacks. All in all, 3% of women hospitalized for STEMI heart attacks died during the study period, compared to 2.6% of men (the death rate for NSTEMI heart attacks was roughly 1% for both sexes).
The team’s findings were published Thursday in the Journal of the American Heart Association.
What to do about the rise in heart attack deaths
This sort of research can’t tell us directly why Americans under 55 are dying more often from their heart attacks, but the researchers did find some potential clues.
In men, for instance, there might have been a disproportionate increase in risk factors linked to heart attacks that are more likely to be fatal. And in both sexes, though classic risk factors like high blood pressure were more common, the researchers found that non-traditional risk factors, particularly kidney disease, having a lower income, or a history of non-tobacco drug use, were more strongly associated with heart attack deaths. Interestingly, though the covid-19 pandemic occurred during the study period, it didn’t seem to have much, if any, impact on the death rate.
As for young women, there are probably several reasons why they continue to have a higher chance of dying from their heart attacks, Satish explained.
“One is the risk factors, which are obviously a higher burden of non-traditional risk factors in women. The second thing was the fact that we saw that women overall are receiving [fewer] procedures,” he said, noting that this gap exists despite women experiencing a similar rate of complications as men from their heart attacks. “And then the third element is the type of complications we’re seeing. Even though the overall complications were pretty similar between young men and women, the complications that could portend higher rates of mortality were much higher within women. So, for example, we saw more cardiogenic shock with STEMI heart attacks in women.”
These findings provide new avenues of research for scientists to dig deeper into this phenomenon. And the research might offer some timely reminders for both younger people thinking about their heart health and doctors.
“Having these discussions [about non-traditional risk factors] earlier on with providers is critical,” Satish said. “And from the provider’s standpoint, it’s understanding that when that discussion starts to happen at earlier ages, and likewise earlier in the mindset of these young folks, that we start to entertain in a thoughtful way the non-traditional elements that seem to augment the risk in young folks.”
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