Heart Attack Deaths Increase Among Younger Adults, Particularly Women, Linked to Nontraditional Risk Factors

A new study published in the Journal of the American Heart Association found that heart attack deaths increased significantly among adults younger than age 55 between 2011 and 2022, with women more likely than men to die after a first heart attack. The research, analyzing nearly 1 million hospitalizations of U.S. adults ages 18-54, showed an absolute 1.2% increase in in-hospital deaths for patients with ST-segment elevation myocardial infarction (STEMI), a severe form of heart attack caused by complete coronary artery blockage.

Women had higher mortality rates at 3.1% for STEMI and 1% for non-STEMI (NSTEMI), a less severe form from partial blockage, compared to men at 2.6% for STEMI and less than 1% for NSTEMI. While women experienced similar rates of in-hospital complications, they received fewer cardiovascular procedures to identify and treat causes of their heart attacks. The findings challenge previous assumptions that heart attack deaths had plateaued or decreased, revealing that any decline appears to have been driven largely by older adults and men.

After accounting for all assessed risk factors, heart attack deaths remained linked more to nontraditional risk factors—including low income, kidney disease, and non-tobacco drug use—rather than traditional factors like high blood pressure or high cholesterol, in both men and women. Women had a higher number of these nontraditional risk factors, with younger women most likely to have them compared to males of the same age. Among STEMI hospitalizations, low income was the most prevalent nontraditional risk factor, affecting nearly 35% of women compared to nearly 29% of men.

Mohan Satish, M.D., the study's lead author, noted that improving heart attack outcomes in adults younger than 55, particularly women, will require earlier risk identification and consideration of nontraditional risk factors to improve treatment. The research analyzed data from the National Inpatient Sample, a nationally representative database including all health insurance claims regardless of payer. Among 945,977 first-time hospitalizations, nearly 40% were for STEMI and more than 62% were NSTEMI.

The study's implications suggest that current risk assessment models may be inadequate for younger populations, especially women. Future studies need to consider how nontraditional risk factors impart heart attack risk along with their impact on traditional risk factors. The American Heart Association's Go Red for Women initiative, which addresses awareness and clinical care gaps for cardiovascular disease in women, highlights this research in a special spotlight issue. Additional information about cardiovascular health can be found at https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack.