Heart Attacks in Women Archives - Health Tips From The Professor

Are Calcium Supplements Safe?

September 3, 2024 by Dr. Steve Chaney

What Does This Study Mean For You?

Author: Dr. Stephen Chaney

Should you avoid calcium supplements because they increase your risk of heart disease? Some headlines and blog posts would have you believe that. You may have been told that by your doctor. But is it true?

Unfortunately, this is another example of the swinging pendulum that we often see in supplement studies. One day a study comes out saying that calcium supplements increase the risk of heart disease. A few months later another study comes out saying that is not true. Calcium supplements don’t increase heart disease risk.

The pendulum keeps swinging until you are totally confused. You don’t know what to believe. And “experts” (including your doctor) pick one side or the other depending on what they believe about supplements in general.

I have told you before that good scientists wait until multiple studies have been done and base their opinion based on what the preponderance of studies show. I can tell you that multiple studies have been done and the preponderance of studies show that calcium supplements do not increase the risk of heart disease. But that doesn’t prove that calcium supplements are safe. It just shows they are likely to be safe.

That is why the authors of the current study (X Huo et al, Current Developments In Nutrition, volume 7, Issue 3: 100046, March 2023) analyzed the weaknesses of previous studies and tried to design a study that lacked those weaknesses.

How Was This Study Done?

The investigators searched through the literature to identify all placebo-controlled, randomized clinical trials (the gold standard for clinical studies) assessing the effects of calcium supplements alone or calcium supplements with vitamin D on heart disease, stroke, and all-cause mortality.

They restricted their analysis to studies with at least 500 participants that lasted for at least a year. They further restricted their analysis to studies whose authors were willing to share unpublished data on the number of participants in each treatment group who had a heart attack, stroke, or any other kind of heart disease; died from heart disease; or died from all causes during the study.

They ended up with 11 clinical studies in their analysis. The breakdown was as follows:

Seven studies with 8,634 participants compared calcium alone with placebo.

- Participants in these studies averaged 71 years old and were 79% female.

- The daily calcium dose varied from 1.0 to 1.5 g/day.

- The mean duration of treatment was 4.1 years (range = 2-5 years).

Six studies with 46,804 participants compared calcium plus vitamin D with placebo.

- Participants in these studies averaged 65 years old and were 98% female.

- The daily calcium dose varied from 1.0 to 1.5 g/day and the daily vitamin D dose ranged from 400 to 2,000 IU/d.

- The mean duration of treatment was 6 years (range = 1.5-7 years).

In case you were wondering about the math, some studies included both calcium alone versus placebo and calcium plus vitamin D versus placebo.

The authors then combined the data from all 11 studies and performed a meta-analysis on the effect of calcium alone on adverse heart outcomes and calcium plus vitamin D on adverse heart outcomes.

Are Calcium Supplements Safe?

The results were clear-cut.

Calcium alone was not significantly associated with any increased risk of heart attack, stroke, heart disease of any kind, deaths from heart disease, and deaths from all causes.

Calcium with vitamin D was not significantly associated with any excess risk of heart attack, stroke, heart disease, deaths from heart disease, and deaths from all causes.

In their discussion, the authors pointed out two caveats to their conclusions:

In the calcium only portion of the meta-analysis the number of participants who experienced a stroke or types of heart disease other than heart attack and stroke was very small. So, they could not exclude an absolute increased risk of 0.3-0.5% per year for these types of rare events.

The participants in the 11 studies included in their meta-analysis were not selected based on their risk of heart disease. So, the authors could not exclude the possibility that calcium supplements might increase the risk of heart disease in people who were already at high risk of heart disease.

The authors concluded, “This meta-analysis demonstrated that calcium supplements were not associated with any significant hazard for heart disease, stroke, or all-cause mortality…Hence, for people with low bone density and low absolute risks of heart disease, the present report demonstrates no concern about excess heart disease risks associated with calcium supplements.

However, further large trials are needed to assess the efficacy and safety of combined supplementation with calcium and vitamin D for the prevention of osteoporotic fracture in older people at high risk of heart disease.”

What Does This Study Mean For You?

As I said above, the preponderance of evidence suggests that calcium supplementation does not increase your risk of heart disease. This study reinforces that conclusion.

I can’t guarantee that some future study won’t come to the opposite conclusion, and the pendulum will swing again. And I can’t guarantee that your doctor has kept up with the most recent literature on calcium supplementation and heart disease risk.

The authors of this study also pointed out that we don’t have any clinical studies on the effect of calcium on heart disease risk if you are already at high risk of heart disease. So, if you are at high risk of heart disease, any advice that I or your doctor give you about calcium supplementation might be wrong. We simply don’t know.

Finally, I realize that you may be equally confused about whether calcium supplementation can strengthen your bones and reduce your risk of osteoporosis. I won’t discuss that question today. Instead, I will refer you to two previous articles I have written in “Health Tips From the Professor” on that topic.

The first article discusses the flaws in previous studies claiming that calcium supplements are ineffective at increasing bone density and preventing osteoporotic fracture.

The second article describes a bone-healthy lifestyle.

The Bottom Line

While the preponderance of studies have shown that calcium supplementation does not increase the risk of heart disease, that conclusion remains controversial.

To clarify that issue, a group of investigators searched through the literature to identify all placebo-controlled, randomized clinical trials (the gold standard for clinical studies) assessing the effects of calcium supplements alone or calcium supplements with vitamin D on heart disease, stroke, and all-cause mortality. They then performed a meta-analysis of those clinical studies.

Their meta-analysis showed that:

Calcium alone was not significantly associated with any increased risk of heart attack, stroke, heart disease of any kind, deaths from heart disease, and deaths from all causes.

Calcium with vitamin D was not significantly associated with any excess risk of heart attack, stroke, heart disease, deaths from heart disease, and deaths from all causes.

This study strengthens the conclusion that calcium supplementation does not increase the risk of heart disease.

For more details about the study and references discussing the effect of calcium supplementation on bone density, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

______________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

_______________________________________________________________________

About The Author

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years. Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 45 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

Is The Mediterranean Diet Healthy For Women?

May 28, 2024 by Dr. Steve Chaney

What Does This Study Mean For You?

Author: Dr. Stephen Chaney

There is a well-known health disparity in clinical studies related to health. For years most of the studies have been done by men for men. Women have been assumed to experience the same benefits and risks from diet choices as men. But that hasn’t always proven to be true.

The Mediterranean diet is no exception. For example, it has garnered a reputation of reducing heart disease risk for both men and women.

However, most studies on the Mediterranean diet have included primarily male participants or did not report sex specific differences in outcomes.

And the few studies that reported sex specific outcomes have been inconsistent.

Some studies have found that men and women benefitted equally from the Mediterranean diet.

Other studies have reported that men benefitted more than women.

However, these were all small studies. No meta-analyses have been reported that focused on the heart benefits of the Mediterranean diet for women.

The study (A Pant et al., Heart; 109: 1208-1215, 2023) I will describe today was designed to fill that gap.

How Was The Study Done?

The investigators started by screening the literature to find studies that:

Measured adherence to the Mediterranean diet using the original MDS (Mediterranean Diet Score) or more recent modifications of the MDS.

Included women ≥18 years without previous diagnosis of clinical or subclinical heart disease.

Performed the study with only women participants or organized their data so that the data pertaining to women could be extracted from the study.

The investigators then performed a meta-analysis on data from 722,495 women in 16 studies published between 2006 and 2021 that met these criteria. These studies followed the women for an average of 12.5 years. The studies were primarily conducted in the United States and Europe.

The individual studies divided participants into either quintiles or quartiles and compared participants with the highest adherence to the Mediterranean diet to those with the lowest adherence.

The primary outcomes measured were total mortality and the incidence of CVD, cardiovascular disease (defined as including CHD (coronary heart disease), myocardial infarction (heart attack), stroke, heart failure, and cardiovascular death).

The secondary outcomes measured were stroke and CHD, coronary heart disease (heart disease caused by atherosclerotic plaque build up in the coronary arteries).

Is The Mediterranean Diet Healthy For Women?

When comparing the highest to the lowest adherence to the Mediterranean diet:

The incidence of CVD (cardiovascular disease) was reduced by 24%.

Total mortality during the ~12.5-year follow-up was reduced by 23%.

The incidence of CHD (coronary heart disease) was reduced by 25%.

The risk of stroke was reduced by 13%, but that risk reduction was not statistically significant.

- The risk reduction for both CVD and total mortality was similar to that previously reported for men.

- Risk reduction for CVD was slightly higher for women of European descent (24%) than for women of non-European descent (21%). The later category included women of Asian, Native-Hawaiian, and African – American descent.

The authors concluded, “This study supports a beneficial effect of the Mediterranean diet on the primary prevention of CVD and death in women and is an important step in enabling sex-specific guidelines.”

I would add that the data from women of non-European decent suggests that genetic background and/or ethnicity may influence the effectiveness of the Mediterranean diet at reducing heart disease risk, but this effect appears to be small.

What Does This Mean For You?

The results of this study are not unexpected. But that doesn’t mean that studies with women are not valuable. There have been several examples in recent years where health or medical advice based on studies with men needed to be modified for females once the studies were repeated with women.

Before covering what this study means for you, I should point out that while women often fear breast cancer most, heart disease is their number one killer, as the graph on the left shows. In fact, a woman’s risk of dying from coronary heart disease is 6 times greater than her risk of dying from breast cancer.

This study shows that following a Mediterranean–style diet lowers their risk of developing and dying from heart disease. But the Mediterranean diet is not alone in providing these health benefits. It is simply a whole food, primarily plant-based diet that reflects the food preferences of the Mediterranean region.

The DASH diet, which reflects the food preferences of Americans, and the Nordic diet, which reflects the food preferences of the Scandinavian countries, are equally heart healthy. In fact, any whole food, primarily plant-based diet will reduce the risk of heart disease. You should choose the one that best fits your food preferences and lifestyle.

Of course, diet is just part of a holistic approach for reducing heart disease risk. Other important risk reduction strategies include:

Don’t smoke.

Exercise and maintain a healthy weight.

Manage stress.

Avoid or limit alcohol.

Know your numbers (cholesterol, triglycerides, and blood pressure, for example).

Manage other health conditions that increase the risk of heart disease (high blood pressure, diabetes, and high cholesterol, for example).

The Bottom Line

Most studies on the heart health benefits of the Mediterranean diet have been done with men or have not analyzed the data from men and women separately. A recent meta-analysis combining data from 16 studies with 722,495 women showed that the Mediterranean diet was just as heart healthy for women as it was for men.

For more details on this study and information on other diets that are heart healthy, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

_____________________________________________________________________________My My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

_____________________________________________________________________

About The Author

Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”.

Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Are Calcium Supplements Heart Healthy?

February 6, 2024 by Dr. Steve Chaney

Should You Follow Your Doctor’s Advice About Calcium Supplementation?

Author: Dr. Stephen Chaney

Are calcium supplements good for your heart or bad for your heart? If you don’t know the answer to that question, don’t feel badly. You have every right to be confused. Some studies say that calcium supplements increase heart disease risk while others say they decrease heart disease risk. The headlines have veered between “killer calcium” and “beneficial calcium”.

The trend appears to be moving in a positive direction. In recent years most of the studies have suggested that calcium supplements either decrease heart disease risk or have no effect on heart disease risk.

However, the medical profession has been slow to take note of this trend. Most medical societies and health professionals have focused on earlier studies and are still recommending that their patients get calcium from food rather than from supplements. I will talk more about that recommendation below.

With this context in mind, this week I will review and discuss the results from the latest study (MG Sim et al, Heart, Lung and Circulation, 32: 1230-1239, 2023) on the effect of calcium supplementation on heart disease risk.

How Was This Study Done?

The authors of this study performed a meta-analysis of 12 double-blinded randomized clinical trials with 87,899 participants comparing the effect of a calcium supplement versus a placebo on heart disease outcomes (heart attack, stroke, heart failure, cardiovascular mortality, and all-cause mortality).

The studies included in this analysis:

Used calcium doses from 500 mg/day to 2,000 mg/day.

Used supplements with calcium coming from a variety of sources (calcium carbonate, calcium citrate, calcium gluconolactate, and tricalcium phosphate).

Ranged from 18 months to almost 12 years in length.

Were performed with population groups from a wide range of countries (United States, England, France, Australia, New Zealand, European Union, Denmark, and Thailand).

Included calcium supplements with and without vitamin D.

Were primarily (86% of participants) conducted with post-menopausal women. One small study (0.3% of participants) was conducted with non-osteoporotic men. The rest were conducted with mixed populations (men and women) diagnosed with colorectal adenoma.

Are Calcium Supplements Heart Healthy?

This is the largest meta-analysis performed to date of double-blind, placebo-controlled randomized clinical trials on the effect of calcium supplementation versus a placebo on heart disease outcomes. This study found no effect of calcium supplementation on:

Heart attack.
Stroke
Heart failure.
Cardiovascular mortality.
All-cause mortality.

This study also evaluated potential confounding variables and found no effect of calcium supplementation on heart disease risk for:

Calcium supplements with and without vitamin D.

Dosage of calcium in the supplements (The dosage ranged from 500 mg/day to 2,000 mg/day).

Females (I suspect the number of males in this study was too small to come to a statistically significant conclusion).

Duration of calcium supplementation ≤ 5 years (The shortest duration of calcium supplementation in these studies was 18 months).

Different geographical regions.

However, this meta-analysis reported considerable variation between studies included in the analysis. Simply put,

Some studies showed an increase in heart disease risk.
Some studies showed a decrease in heart disease risk.
Some studies showed no effect on heart disease risk.

What this analysis showed was that when you combine all the studies, the aggregated data is consistent with calcium supplementation having no effect on heart disease risk.

The authors concluded, “Calcium supplementation was not associated with myocardial infraction [heart attack], stroke, heart failure, and cardiovascular/all-cause mortality. Further studies are required to examine and understand these associations.

Should You Follow Your Doctor’s Advice About Calcium Supplementation?

As I said above, most medical societies and health professionals have focused on earlier studies and are still recommending that their patients get calcium from food rather than from supplements. That may be the advice you are getting from your doctor.

Before you assume your doctor isn’t keeping up with the latest science and ignore his or her advice, we should ask why they are giving that advice. The top three reasons most medical societies give for recommending dietary sources of calcium are:

1) Some studies do show an increased risk of heart disease associated with calcium supplementation. The prime directive for health professionals is to do no harm. Yes, the average of all studies shows no effect of calcium supplementation on heart disease risk. But what if the studies showing increased risk are true for some of their patients? Those patients could be harmed.

Are you someone who might be at increased risk for heart disease if you take calcium supplements. The short answer is we don’t know because previous studies have not asked the right questions.

In my opinion, it is time to pause additional studies and meta-analyses on calcium supplementation and heart health until we have gone over existing studies with a fine-tooth comb to figure out why the results differ so wildly. For example, we need to ask whether the effect of calcium supplements on heart disease risk is influenced by things like:

- Age or ethnicity of participants.

- Other preexisting health conditions.

- Other lifestyle factors (exercise is probably the most important, but others may be involved as well).

- Diet context. For example, we already know that the effect of eggs and dairy on heart health is influenced by diet context. [I have covered this for eggs in a previous issue of “Health Tips From the Professor”.]

- Other unanticipated variables.

Only when we have identified variables that might influence the effect of calcium supplements on heart disease risk, will the scientific community be able to design studies to identify the population groups who might be adversely affected by calcium supplementation.

This would allow health professionals to make informed decisions about which of their patients should avoid calcium supplementation and which of their patients would benefit from calcium supplementation.

2) We really don’t need the recommended RDAs for calcium to build strong bones. The recommended RDAs for calcium are 1,000 mg/day for adults 19-50, 1,000 mg/day for men and 1,200 mg/day for women 51-70, and 1,200 mg/day for both men and women over 70. But do we really need that amount of calcium to build healthy bones?

I have discussed this topic in detail in a previous issue of “Health Tips From the Professor”. Here are the key points:

- The current RDAs are based on calcium needs for people consuming the typical American diet and following the typical American lifestyle. If that is you, the current RDAs probably apply.

- However, strong bones are absolutely dependent on three things, adequate calcium, adequate vitamin D, and adequate weight-bearing exercise. Most recent studies of calcium supplementation and bone density include adequate vitamin D, but almost none of them include exercise. Previous studies have been inadequate.

- The best calcium supplements contain certain nutrients besides vitamin D that optimize bone formation. I have listed those nutrients in the article cited above.

- Our ability to use calcium to build strong bones is dependent on diet (something I call a bone-healthy diet) and lifestyle (something I call a bone-healthy lifestyle).

- For more information on each of these points, read the article I referenced above.

In short, I agree that the current calcium RDAs may be too high for individuals consuming a bone-healthy diet and following a bone-healthy lifestyle. But the current calcium RDAs are likely accurate for people consuming the typical American diet and following the typical American lifestyle.

- While we do not have a calcium RDA for populations following a bone healthy diet lifestyle, some studies suggest that 700-800 mg of calcium/day may be sufficient for this group.

3) Calcium from supplements is absorbed faster and gives higher blood level spikes than calcium from foods. That could be a problem because high blood levels of calcium are associated with calcification of our arteries, which is associated with increased heart disease risk.

This is a theoretical concern, because high blood calcium levels from supplementation are transitory, while it is continuous high blood calcium levels that are associated with calcification of our arteries.

However, it is a plausible concern because most supplement companies design their calcium supplements based on how quickly they get calcium into the bloodstream rather than how effectively the calcium is utilized for bone formation. Here are my recommendations:

- Choose a calcium supplement that provides RDA levels of vitamin D plus other nutrients shown to support strong bone formation.

- Choose a calcium supplement supported by clinical studies showing it is effectively utilized for bone formation.

4) We should be getting our calcium from foods rather than supplements.

While it is always easy for doctors to recommend that we get our nutrients from food rather than supplements, they need to ask whether we are getting those nutrients from our diet. For calcium the data are particularly sobering.

- The average American gets around 740 mg of calcium/day from their diet. That is probably enough for the small percentage of Americans following a bone healthy diet and lifestyle. But it is 260-460 mg short of the 1,000-1,200 mg/day recommended for older adults with the typical American diet and lifestyle.

- - And for the average American, around 70% of their calcium intake comes from dairy foods.
  - So, Americans who are following a typical American diet and lifestyle and are restricting dairy may require 800-1,000 mg/day of supplemental calcium unless they carefully plan their diets to optimize calcium intake.
  - Finally, vegans average about 550 mg/day from their diet. That might be borderline even if they were following a bone healthy lifestyle.

- In short, we cannot assume our diet will provide enough calcium for strong bones unless we include dairy foods and/or plan our diet very carefully. Some degree of supplementation may be necessary.

How Much Calcium Do You Need?

I have covered a lot of territory in this article, so let me summarize the four concerns of the medical community and answer your most important question, “Should you take calcium supplements?”

1) Calcium supplements may increase the risk of heart disease for some people.

That is true, but we have no idea at present who is at increased risk and who isn’t. So, we should minimize our risk by taking the precautions I describe below.

2) We don’t need RDA levels of calcium to build strong bones. That is probably true if you are one of the few people who follows a bone healthy diet and lifestyle, but it isn’t true if you follow the typical American diet and lifestyle.

The current RDAs of 1,000 – 1,200 mg/day are a good guideline for how much calcium you need if you follow the typical American diet and lifestyle.

If you a one of the few people who follow a bone healthy diet and lifestyle (For what that involves, read this article) you may only need 700-800 mg/day. But we don’t have clinical studies that can tell us what the actual RDA for calcium should be under those circumstances.

3) Calcium from supplements is absorbed faster and gives higher blood calcium spikes than calcium from foods. You may remember that the theoretical concern is that even short-term spikes of high blood calcium may lead to calcification of your arteries, which increases your risk of heart disease. So, the important question becomes, “What can we do to minimize these spikes in blood calcium levels?”

We should avoid calcium supplements that brag about how quickly and efficiently the calcium is absorbed. That could lead to calcium spikes. Instead, we should look for calcium supplements that are backed by clinical studies showing they are efficiently utilized for bone formation.

We should look for calcium supplements that include RDA levels of vitamin D and other nutrients that optimize bone formation. You will find more information on that in the same article I referenced above.

Some experts recommend that calcium supplements be taken between meals. But it is probably better to take them with meals because foods will likely slow the rate at which calcium is absorbed and reduce calcium spikes in the blood.

We are told to limit calcium supplements to less than 500 mg at any one time because calcium absorption becomes inefficient at higher doses. It might be even better to limit calcium to 250 mg or less at a time to reduce calcium spikes in the blood.

4) We should get calcium from foods rather than supplements.

Many Americans do not get enough calcium from diet alone, especially if they avoid dairy foods. So, some degree of calcium supplementation may be necessary. I have given some guidelines depending on your diet and lifestyle above.

The amount of supplemental calcium needed is relatively small. I do not recommend exceeding the RDA unless directed to by your health professional.

The Bottom Line

Some studies say that calcium supplements increase heart disease risk while others say they decrease heart disease risk. The headlines veer between “killer calcium” and “beneficial calcium”.

A recent meta-analysis of 12 double-blinded randomized clinical trials with 87,899 participants comparing the effect of a calcium supplement versus a placebo on heart disease outcomes has just been published. This study found no effect of calcium supplementation on:

Heart attack.
Stroke.
Heart failure.
Cardiovascular mortality.
All-cause mortality.

The authors of the study concluded, “Calcium supplementation was not associated with myocardial infraction [heart attack], stroke, heart failure, and cardiovascular/all-cause mortality.

For more details and advice on whether you should follow your doctor’s recommendations for calcium supplementation read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

_____________________________________________________________________________

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

____________________________________________________________________

About The Author

Are Heart Attacks Increasing in Young Women?

April 2, 2019 by Dr. Steve Chaney

Why Are Heart Attacks Increasing In Young Women?

Author: Dr. Stephen Chaney

Heart disease is still the leading cause of death in the United States, but things seemed to be getting better. More people are following heart-healthy diets and the treatment of heart disease has improved. One recent study found that the overall rate of heart disease has decreased by 38% in the U.S. since 1990. Heart attack rates have also been inching down in recent years.

Are heart attacks increasing in young women?

That’s why the latest study was both surprising and concerning. If it is to be believed, heart attack rates are increasing in young Americans, especially young women. That is particularly shocking because young women are thought to be protected from heart disease by their estrogen. Until recently, heart attack rates have been lower for young women than for young men. It hasn’t been until after menopause that women caught up to men in terms of their risk for a heart attack.

Obviously, this study raises several questions:

Is it true?
Why are heart attacks increasing in young women?
What should young women be doing to prevent heart disease?

How Was The Study Done?

This study (S Arora et al, Circulation, 139: 1046-1056, 2019 was an offshoot of the Atherosclerosis Risk in Communities (ARIC) Surveillance Study. The ARIC study collected data on hospital admissions for acute myocardial infarction (or in layman terms, heart attacks) for patients aged 35-74 in four geographical areas in the U.S. (Forsyth County in North Carolina, Washington County, Maryland, Jackson, Mississippi, and the Northwest suburbs of Minneapolis, Minnesota).

During the time period of 1995 to 2014 28,732 people ages 35-74 were admitted to one of the participating hospitals for a heart attack. The results of the original study have been published previously (WD Rosamond et al, Circulation, 125: 1848-1857, 2012 ). For the population as a whole:

The annual rate of hospital admissions for a heart attack decreased by around 3.5% during this time period, and…
The annual rate of death following a heart attack decreased by around 3%.

However, the current study focuses on the younger people in the study (ages 35-54) and came to a surprisingly different conclusion. Contrary to the results obtained with the general population, the rate of heart attacks increased in younger people.

What Did The Study Show?

Although the article uses the terms “young adults” and “young women,” I realize that some of you may consider that misleading. My only comment is whether you consider the 35-54 age range to be “young” or not probably depends on which side of 35 you are on.

Having said that, when the authors compared younger people in the study (the 35-54 age group) with everyone in the 35-74 age group they found:

The overall proportion of hospitalizations for heart attack among young people increased from 27% in 1995 to 32% in 2014.
The increase in heart attack rate was most dramatic for young women.
Hospitalizations for heart attack increased from 30% to 33% for young men. This increase was non-significant.
Hospitalizations for heart attack increased from 21% to 31% for young women. This increase was highly significant.
This is a wake-up call. We now appear to be entering an era in which heart attack rates for young women (ages 35-54) equal those of young men. The protective effects of estrogen have disappeared.

Why Are Heart Attacks Increasing In Young Women?

As I said at the beginning, there are several questions we need to answer:

Is this study true? There are some limitations to this study, but it is a fairly robust study. A similar study in Canada came to the same conclusion, and several other studies have suggested a similar trend. More research is needed, but this is a very disturbing finding.
Why are heart attacks increasing in young women? The short answer to this question is that we don’t know. However, the study offers several hints.
Hospitalizations for heart attack were highly correlated with a history of high blood pressure and diabetes. Obesity was not measured in this study, but it increases the risk of both high blood pressure and diabetes. Experts have been warning for years that the obesity epidemic may undo all the progress we have made at reducing heart disease deaths. This study may be the first indication that the prediction is coming true.
Young women were less likely than young men to be receiving lipid-lowering medications and other medications to reduce heart disease risk at the time of admission for their first heart attack. This may reflect a perception among both patients and physicians that young women are less likely to develop heart disease than young men.
Young women may be less likely to seek medical advice about how to control obesity, high blood pressure and diabetes, and medical professionals may not treat these conditions as aggressively as they do for young men.
The current study suggests the perception that obesity, high blood pressure and diabetes are less likely to cause heart attacks in young women than in young men is no longer true, if it ever was.
The early symptoms of a heart attack are different for women than for men. For men heart attacks are associated with chest pain. For women early symptoms of an impending heart attack may be back pain, nausea, or dizziness. Both women and their doctors may not recognize these symptoms early enough to fend off a full-blown heart attack.
What should young women be doing to prevent heart disease? This is the topic of the next section.

What Should Every Woman Know About Heart Disease?

There are several simple lessons every woman should take from this and similar studies.

Heart disease is not a male disease. If that were ever true, it is definitely no longer true.
Don’t assume your risk is low until you reach menopause. This study suggests today’s young woman is just as likely to have a heart attack as a young man.
Obesity, high blood pressure, and diabetes are killers. The good news is that if you start while you are young, you can reverse these killers with diet and lifestyle changes.
A heart healthy diet and lifestyle is important at every age. Don’t fall for the diet fads. Despite what Dr. Strangelove’s health blog would have you believe, saturated fats increase your risk of heart disease. A whole-food, primarily plant-based diet is the only proven dietary approach for reducing heart disease risk long term. For more information on how you can protect your heart, read my books. “Slaying The Food Myths” and “Slaying The Supplement Myths”.
Get regular checkups. If you develop risk factors for heart disease, don’t ignore them. Treat them aggressively. This requires a partnership between you and your doctor. Your part of the partnership is to make the necessary lifestyle changes to reverse these risk factors. Your doctor’s role is to provide appropriate medications to control these risk factors if you are unable to control them with lifestyle changes alone.

The Bottom Line

While heart disease has been declining in the general population, a recent study has shown that heart attacks are on the increase for young adults. In particularly, heart attacks are increasing in young women.

The overall proportion of hospitalizations for heart attack among young people increased from 27% in 1995 to 32% in 2014.
The increase in heart attack rate was most dramatic for young women.
Hospitalizations for heart attack increased from 30% to 33% for young men. This increase was non-significant.
Hospitalizations for heart attack increased from 21% to 31% young women. This increase was highly significant.
This is a significant and disturbing finding. We now appear to be entering an era in which heart attack rates for young women equal those of young men. The protective effects of estrogen have disappeared.
Note: The authors defined 35-54 years old as young. Whether you consider that young or not probably depends on which side of 35 you are on.
Hospitalizations for heart attack were highly correlated with a history of high blood pressure and diabetes. Obesity was not measured in this study, but it increases the risk of both high blood pressure and diabetes. Experts have been warning for years that the obesity epidemic may undo all the progress we have made at reducing heart disease deaths. This study may be the first indication that the prediction is coming true.

For more details and my recommendations for what every woman should know about heart disease read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.