Study details

For the study, researchers analyzed the health data of adults ages 18 to 54 from 2011 to 2022 using the National Inpatient Sample, a nationally representative database that includes all health insurance claims regardless of payer.

The researchers then looked at first-time hospitalizations for two types of heart attacks: ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). STEMI is a more severe heart attack caused by a complete blockage of a coronary artery, while NSTEMI is a less severe heart attack caused by a partial blockage of a coronary artery.

Of the 945,977 first-time hospitalizations for heart attacks that the researchers analyzed, almost 40% were for patients with STEMI while more than 62% were for patients with NSTEMI. Overall, after considering both hospital and patient characteristics, the researchers found that in-hospital deaths for first-time STEMI heart attacks increased by 57% between 2011 and 2022, going from 2.1% to 3.3%. The study did not find a significant change in the death rate from NSTEMI heart attacks.

The researchers also found that women were more likely to die from a first-time heart attack than men and, while women experienced similar rates of in-hospital complications to men, they received fewer cardiovascular procedures than men to identify and treat causes of their heart attacks.

Discussion

The study's findings add to a growing body of evidence showing women facing growing heart risks. A study published last week in Circulation found that rates of heart disease are expected to increase significantly for women and occur at a younger age over the next 25 years.

The increase in fatal heart attacks among people under the age of 55 is especially concerning because mortality from heart attacks has generally been on the decline, Satish said.

"U.S. heart attack deaths appeared to have plateaued or decreased, based on observational studies that extended into 2010. However, that decline appears to have been driven largely by older adults and men," he said. "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."

The findings signal "we have this epidemic of cardiovascular risk," said Karen Joynt Maddox, a cardiologist, professor, and health policy researcher at Washington University in St. Louis.

Sadiya Khan, professor of cardiovascular epidemiology at Northwestern University, said younger adults need to recognize their risk for a heart attack. She recommended they use the risk calculator on the American Heart Association's website, which she helped develop, and ensure they get a 30-year estimate rather than a 10-year one.

"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. "Future studies need to consider how nontraditional risk factors impart heart attack risk along with their impact on traditional risk factors."

Satish added that having discussions with providers about non-traditional risk factors "is critical."

"And from the provider's standpoint, it's understanding that when that discussion starts to happen at earlier ages, and likewise earlier in the mindset of these young folks, that we start to entertain in a thoughtful way the non-traditional elements that seem to augment the risk in young folks," he added.