A new study published in a Go Red for Women spotlight issue of the Journal of the American Heart Association reports that heart attack deaths increased significantly among adults younger than age 55 between 2011 and 2022, with women experiencing higher mortality rates than men. The analysis of nearly 1 million hospitalizations found an absolute 1.2% increase in deaths among patients hospitalized with a first severe heart attack, challenging assumptions that heart attacks primarily affect older populations.
Women were more likely to die in the hospital from both severe and less severe heart attack subtypes compared to men. For the more severe ST-segment elevation myocardial infarction (STEMI), caused by complete coronary artery blockage, women had a 3.1% mortality rate versus 2.6% for men. For non-STEMI heart attacks resulting from partial blockages, women's mortality was 1% compared to less than 1% for men. "We often think heart attacks are mainly an older person's problem; however, our findings indicate that younger adults, especially women, are at real risk," said Dr. Mohan Satish, the study's lead author and a clinical cardiovascular disease fellow at New York Presbyterian/Weill Cornell Medical Center.
The research revealed that nontraditional risk factors—including low income, kidney disease, and non-tobacco drug use—were more strongly linked to heart attack deaths than traditional factors like high blood pressure or high cholesterol. Women had a higher number of these nontraditional risk factors than men of the same age. Among STEMI hospitalizations, nearly 35% of women were in the lowest income level compared to nearly 29% of men, while tobacco use affected 65% of women versus 61% of men. The American Heart Association's Go Red for Women initiative has addressed awareness and clinical care gaps since 2004, with the JAHA Go Red Spotlight issue highlighting cardiovascular disease in women through nearly a dozen manuscripts.
Despite experiencing similar rates of in-hospital complications as men, women received fewer cardiovascular procedures to identify and treat the causes of their heart attacks. The study 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, approximately 40% were for STEMI patients and more than 62% were for NSTEMI patients. White adults represented the majority for both heart attack subtypes at 69.6% in STEMI and 61.7% in NSTEMI hospitalizations.
"Improving heart attack outcomes in adults younger than age 55, particularly women, will require earlier risk identification and consideration of nontraditional risk factors to improve treatment," Satish said. The authors acknowledge limitations including reliance on administrative hospital data that could contain incorrect diagnoses or treatment codes, and the absence of long-term follow-up information after hospital discharge. Additional American Heart Association health information about warning signs of heart attacks is available at https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack.
