Heart attacks are killing more young people—and more women

Heart attacks kill more young people and more women

By Lauren J. Young edited by Tanya Lewis

Heart problems are something most people generally associate with aging, but the risk of developing them might be younger than before. In the United States, a new study reveals that more and more young people hospitalized for heart attacks are dying.

The study reports a steady increase in deaths in recent years among U.S. adults aged 54 and younger who were hospitalized for their first serious heart attack. Increasing trends were seen in both men and women, but younger women experienced higher rates of serious heart attacks. The findings confirm that the demographics most prone to heart attacks are beginning to change, prompting a reconsideration of whether the disease only affects older people. The results were published last week in the Journal of the American Heart Association.

“It’s not just an older person’s problem,” says Mohan Satish, lead author of the study and a cardiologist at Weill Cornell Medicine in New York. Heart attacks are even more common among older people in the United States, but the trend among younger individuals poses “a troubling question,” he says.

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Karen Joynt Maddox, a cardiologist at Washington University in St. Louis who was not involved in the new research, says the new findings show that we are no longer making the same progress in reducing cardiovascular mortality. “I think a lot of young people feel pretty invincible,” she says, “but cardiovascular risk factors don’t particularly care about your age.”

Researchers analyzed nearly 1 million hospitalizations for two types of heart attacks – a severe form called ST-segment elevation myocardial infarction (STEMI) and a less sudden but severe form called non-ST-segment elevation myocardial infarction (NSTEMI) – between 2011 and 2022 in people aged 18 to 54. STEMI occurs when a blood clot completely blocks an artery that supplies blood to the heart, while NSTEMI occurs when a clot partially blocks blood flow. Hospital deaths after a first STEMI in this age group increased by 1.2 percent during the study period. Overall, among people with a first STEMI, women had a slightly higher mortality rate (3.1%) than men (2.6%).

To determine what might be driving these increases, the team looked at more than a dozen risk factors, including traditionally recognized ones such as high cholesterol and high blood pressure, as well as “non-traditional” factors. These include factors such as psychiatric disorders, use of drugs other than tobacco and low income. Three non-traditional risk factors particularly stand out among young people: chronic kidney disease, use of drugs other than tobacco and lower income.

High blood pressure and high cholesterol remain key risk factors in young and older adults, “but clearly in younger adults we can see that these non-traditional risk factors are having an impact,” says Satish.

And nontraditional risk factors could make it more difficult to treat and prevent traditional risk factors, thereby worsening overall health, he adds. For example, if a young person is diagnosed with high blood pressure but also comes from a low socioeconomic background or has a co-occurring autoimmune or psychiatric illness, “this could very well complicate how [a clinician would] “This is essential: the interaction between non-traditional and traditional risks is increasingly important among these young people than among older adults.”

Women also had a higher proportion of non-traditional risk factors than men, which could partly explain gender differences in mortality rates. Additionally, as noted in previous research, women were less likely to undergo in-hospital heart attack procedures, such as operations to repair blockages.

The study focused only on hospital admissions and reporting, which limited scientists’ understanding of recovery outcomes or disease burden after people were discharged, says Marat Fudim, a cardiologist at Duke Health in North Carolina, who was not involved in the research. “They can’t look at post-discharge deaths,” he says, “only hospitalized events.”

Still, Fudim says, the paper aligns with previous research, including his own, that found heart failure death rates increase in people younger than 45. He adds that the new article is a “call to action” for the cardiovascular field. Fudim highlights the need for more focus on early education about traditional and non-traditional risk factors, as well as screening for cardiovascular disease at a younger age.

“We should all be very concerned when young people are now facing more serious cardiovascular disease problems and consequences than ever before,” he says.

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