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• Posted December 22, 2021

Who's Dying Young in U.S. From Heart Attacks?

Fewer Americans are dying prematurely from heart attack compared with years ago, but progress has stalled out in the past decade, new research shows.

For the study, the researchers examined 20 years of data on heart attack deaths among Americans under 65 -- deaths that are considered "premature."

The bigger picture looked good: Between 1999 and 2019, those deaths declined by 52%.

However, after a decade of fairly rapid decline, that progress slowed down after 2011: Up until then, premature heart attack deaths had dropped by 4.3% per year, on average. After 2011, that decelerated to 2.1% per year.

And inside that overarching trend, the study found, certain groups of Americans were at particular risk of dying young from a heart attack.

Black Americans had higher death rates than their white counterparts, while people living in rural areas died at a higher rate than urban dwellers.

The findings were published Dec. 22 in the Journal of the American Heart Association.

The solution is not simply a matter of telling Americans to eat better and exercise, according to researcher Dr. Safi Khan, a cardiology fellow at the DeBakey Heart and Vascular Institute at Houston Methodist Hospital.

Traditional risk factors for heart attack, like high blood pressure, obesity and smoking, certainly matter -- but so do the "social determinants of health," Khan said.

Broadly, that refers to the conditions of people's lives that affect their physical and mental health -- such as education and job opportunities, and access to stable housing, nutritious food and health care. If a family is struggling to pay the bills, for example, a healthy diet is easier said than done; if they have no safe spaces for exercise, it's hard to be physically active.

So "systemic efforts," Khan said, are needed to address premature deaths from heart attack, including the racial and regional disparities seen in the study.

Dr. Connie Tsao, a cardiologist who was not involved in the study, agreed that those wider social factors are critical.

She noted that in the last decade, there has been a "concerning rise" in obesity and diabetes in the United States and globally. And "widening gaps" in social determinants of health likely play a big role, said Tsao, who chairs the American Heart Association's Epidemiology and Prevention Statistics Committee.

"This study and others highlight that there is so much work to be done on a national level to improve cardiovascular health equity," Tsao said.

For the study, Khan's team analyzed death certificate data from a federal database for the years 1999 to 2019.

Overall, premature deaths from heart attack fell over time -- from just over 20 per 100,000 Americans under 65 years of age in 1999, to 10 per 100,000 in 2019.

The gap between Black and white Americans narrowed over time, but death rates remained higher among Black adults. Meanwhile, the decline in deaths slowed after 2011 in both groups, as well as in Hispanic adults -- whose rate of premature death was lower, versus both their white and Black counterparts.

Similarly, while premature deaths dipped over time in rural counties, the rate remained substantially higher compared to urban areas. And after 2011, the rate of decline slowed in both cities and rural areas.

"Innovations have been made, and therapies have improved," Khan said.

But now, he said, there needs to be a focus on helping young people maintain good cardiovascular health from early life, and preventing risk factors for heart disease from developing in the first place.

Tsao said young people need to be aware that what they do now affects their heart health down the road.

"It's important for young people to remember that the accumulation of cardiovascular risk factor burden occurs over years and is rooted in daily habits and activities," she said. "It's also critical for parents and caregivers to instill healthy behaviors in children early in life."

More information

The American Heart Association has advice on following a heart-healthy lifestyle.

SOURCES: Safi Khan, MD, MS, cardiology fellow, DeBakey Heart and Vascular Institute, Houston Methodist Hospital, Houston; Connie Tsao, MD, chairwoman, Epidemiology and Prevention Statistics Committee, American Heart Association, Dallas; Journal of the American Heart Association, Dec. 22, 2021, online