A large-scale study found that the mortality rate from severe heart attacks has increased over the past decade among Americans aged fifty-five and under. What is the reason for this?
For decades, a consistent decline in mortality from heart attacks was recorded, thanks to medical advances, improvements in treatments and a reduction in risk factors such as smoking. However, a new study points to a worrying change among young people in the United States: The mortality rate from severe heart attacks has increased over the past decade among those aged 55 and under.
The study, published in the journal of the American Heart Association, examined national data of patients hospitalized due to a first heart attack between the years 2011 to 2022. The researchers focused in particular on differences between types of heart attacks and on gaps between men and women.
Not every heart attack is the same
The researchers analyzed approximately 950 thousand hospitalizations from the largest national hospitalization database in the United States, which includes approximately seven million hospitalizations per year. The data made it possible to distinguish between two main types of heart attacks.
The first is STEMI, a heart attack caused by a complete blockage of a coronary artery and considered more severe. The second is NSTEMI, caused by a partial blockage and considered less severe.
After adjusting for factors related to patients and hospitals, it was found that the mortality rate from STEMI among those aged 18 to 55 increased during the study period by an absolute rate of 1.2 percent. In contrast, the mortality rate from NSTEMI remained stable.
Gaps between men and women
The increase in mortality from STEMI was more prominent among young men, but young women continued to have a higher risk of dying from a severe heart attack.
Overall, three percent of the women hospitalized with STEMI died during the study period, compared to 2.6 percent of the men. In both sexes, the mortality rate from NSTEMI stood at approximately one percent.
According to the lead researcher, Dr. Mohan Sathish, a cardiologist at NewYork-Presbyterian Hospital, the message to young people is clear: One should not take lightly the risk of a heart attack, even if there are no classic risk factors such as high cholesterol or high blood pressure.
Non-traditional risk factors
The study cannot determine direct causality for the increase in mortality, but it points to possible clues. Alongside an increase in traditional risk factors, stronger associations were found between mortality from heart attacks and factors that are not considered classic.
Among the prominent factors were kidney disease, low income and a history of use of non-tobacco drugs. The researchers note that these factors may have a more significant effect on young people compared to adults.
It is interesting to note that the COVID-19 pandemic, which occurred during the study period, was not found to have a significant impact on mortality rates.
Why women are at higher risk
Regarding young women, the researchers point to several possible explanations. First, it was found that women had a higher prevalence of non-traditional risk factors. Second, women received fewer treatment procedures compared to men, although the overall complication rate was similar.
In addition, the types of complications observed in women were more severe in the context of mortality. For example, cardiogenic shock appeared at a higher frequency among women with STEMI, a condition known to significantly increase the risk of death.
The researchers emphasize that there is a need to deepen the research in order to better understand the mechanisms behind the increase in mortality. At the same time, they call on both young people and physicians to expand the discussion about heart health also at earlier ages.
According to Dr. Satish, it is important to begin discussing non-traditional risk factors already at a young age, and to incorporate them into cardiovascular risk assessment. For many young people, a heart attack is not perceived as a real threat, but the new data point to a more complex reality.
The findings emphasize that heart health is not the exclusive domain of adults, and that lifestyle changes, management of chronic diseases and early identification of risk factors can be critical also in the third and fourth decades of life.