Are Heart Attacks Increasing in Young Women?

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.