Heart Attack Patients are Getting Younger

By Will Boggs MD

NEW YORK (Reuters Health) - Young adults, especially young women, make up an increasing proportion of patients hospitalized with acute myocardial infarction (AMI), according to results from the Atherosclerosis Risk in Communities (ARIC) Surveillance study.

Mortality from coronary artery disease has decreased dramatically in the past four decades in the U.S., but hospitalizations for AMI among young adults have not declined.

Dr. Melissa C. Caughey of the University of North Carolina School of Medicine, in Chapel Hill, and colleagues used ARIC data to examine trends in the incidence of AMI admissions among young women and men (35 to 54 years of age) from 1995 to 2014.

During this interval, the proportion of AMI admissions attributable to this age group increased significantly from 27% to 32%.

This trend was significant among young women (from 21% to 31%) but not among young men (30% to 33%), according to the report, published online November 11 in Circulation to coincide with a presentation at the American Heart Association meeting in Chicago.

Compared with young men, young women admitted with AMI had more comorbidities, but were less likely to have ST-segment elevation MI.

Young women were also less likely to be administered lipid-lowering medications, non-aspirin antiplatelet therapy, beta-blockers, or ACE inhibitors/angiotensin receptor blockers, and less often underwent invasive coronary angiography or revascularization.

Despite these differences, the overall all-cause mortality was similar between women and men (1% vs. 2% in-hospital, respectively, 4% each at 28 days, and 9% vs. 7% at one year).

"Clinical trials designed specifically for women are required to understand further the distinct cardiovascular risk profile and to define treatment pathways in women," the researchers conclude. "Expanding initiatives such as the American Heart Association Go Red for Women campaign to increase awareness about cardiovascular disease risk in women through media and other outlets should also be encouraged."

"An integrated, multifaceted approach is needed to promote effective primordial, primary, and secondary prevention strategies among at-risk women," they add.

Dr. Raffaele Bugiardini of the University of Bologna, in Italy, who recently reviewed acute coronary syndromes in young women, told Reuters Health by email, "These data imply that women and physicians all need greater awareness that heart attacks do occur in young and middle-aged women. Heart attacks are often seen as something that affects older women, yet more young women than ever before are at risk, and the stakeholders have no idea of such risk."

"We believe that the equal risk-adjusted mortality in the face of lower revascularization and evidence-based therapies prescription in women is counterintuitive and differs from other published data," said Dr. Bugiardini, who was not involved in the new work. "We feel that resolving this paradox is important, because misinterpretations could lead physicians and researchers to pull back from the appropriate consideration of the influence of disparities in treatment on sex-related mortality in myocardial infarction."

"We need to realize that sex disparities still exist, but behind disparities, there are also differences," he added. "Attributing sex differences in myocardial infarction mortality entirely to disparities in treatment may actually understate the sex bias at play. Unless the effects of sex are studied, we will continue to have gaps in the knowledge, which may result in missed opportunities for discovering better health for women."

Dr. Caughey did not respond to a request for comments.

SOURCE: https://bit.ly/2DIRmlQ

Circulation 2018.

(c) Copyright Thomson Reuters 2018. Click For Restrictions - https://agency.reuters.com/en/copyright.html

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