Heart disease deaths declined for older Americans, but nearly plateaued for young women

Coronary heart disease (CHD) mortality rates have fallen dramatically over the past four decades among older Americans. But, digging deeper, the data also show that CHD incidence has plateaued in younger Americans, particularly young women, according to a study published online August 24, 2015 in Circulation.

The study’s researchers reported that the age-adjusted CHD mortality rate for both men and women across the overall study period declined by an impressive 68%.

But this good news conceals large differences across demographic groups. “The observed decline mainly reflects CHD mortality reductions among older adults,” the researchers wrote in the Circulation article. “Young individuals, especially women, continue to show much slower reductions in CHD mortality, bordering on stagnation.”

For this study, investigators used the U.S. National Vital Statistics database to track CHD mortality data for U.S. men and women 25 years and older between 1979 and 2011.

They found:

• Death rates in adults 65 and over declined consistently over the decades, with accelerating improvements since 2000 (down 5.0% in men and 5.8% in women).
• Death rates in men and women under age 55 declined between 1979 and 1989—down 5.5% in men and 4.6% in women—but then improvement slowed.
• Death rates in young men fell 1.2% between 1990 and 1999, and 1.8% since 2000.
• The annual change in death rates in young women showed no improvement between 1990 and 1999, and has only fallen 1% since 2000.

“A possible reason for the slow decline in CHD mortality among young people in recent decades is that prevention guidelines may disproportionately underestimate risk in a younger population,” said senior author Viola Vaccarino, MD, PhD, professor and chair of epidemiology at Emory University’s Rollins School of Public Health in Atlanta, GA.

Rising rates of diabetes and obesity in younger adults could contribute to the lack of improvement. “Some reports suggest that diabetes and obesity may pose a greater heart disease risk in younger women than in other groups, and women need to become more aware of the heart risks of these conditions,” Dr. Vaccarino said.

In addition, clinicians may need to look beyond the traditional risk factors of high blood pressure and cholesterol to improve heart disease prevention in adults under age 55.

“Non-traditional risk factors may be especially important in the younger age group,” Dr. Vaccarino said. “For example, in other research we and others have done, factors such as stress and depression are particularly common among young women with early-onset heart disease, and are powerful predictors of heart disease or its progression in this group.”

She added, “This population has not been studied as much as older groups, partially because they are generally considered to be at low risk. There is an urgent need for more research.”