Heart disease is the leading cause of death, and accounts for about 1 in 4 deaths in the United States, according to the Centers for Disease Control and Prevention (CDC). Death due to acute myocardial infarction, more commonly known as a heart attack, is a major contributor to that, said lead author Safi U. Khan, MD, a cardiology fellow at the DeBakey Heart and Vascular Institute at Houston Methodist Hospital in Houston, in an American Heart Association (AHA) release. Although the number of premature heart attacks has declined in the past 20 years, there are some subgroups of people where progress has stalled, according to the authors. By identifying those individuals who are most likely to have an early heart attack, this research may provide important information to shape and target preventive heart disease interventions, said Dr. Khan. Researchers used data from the CDC’s Wide-Ranging OnLine Data for Epidemiologic Research (WONDER) database. Between the years 1999 to 2019, a total of 615,848 people had premature heart attack listed as their primary cause of death. In order to compare the risk of death due to early heart attack, the deceased individuals were then put into groups: young (18 to 44 years old) and middle-aged (45 to 64 years old), male and female, ethnicity and race, states and counties, and urban and rural. Researchers found significant disparities in the likelihood of premature death due to heart attack related to sex, race and ethnicity, and where a person lived.
Death rates were nearly 3 times higher for men compared with women, 20 versus 7.3 per 100,000 person-years.Death rates were higher among Black adults than white adults, 17.5 versus 13.7 per 100,000 person-years.There were higher death rates in Southern states, including Arkansas, Mississippi, Kentucky, Louisiana, and Tennessee, compared with Western and Northeastern states.Death due to heart attack was much more common in middle-aged adults compared with younger adults, at 34.9 versus 2.5 per 100,000 person-years.Premature death rates due to heart attack has not declined as much in rural counties compared with urban counties. The average annual percent decline was 4.2 per year in large metro areas compared with only 2.4 per year in rural counties.
Person-years is a way to estimate the incidence of a new case or event over a specified period of time, according to StatPearls. “Twenty deaths due to premature heart attack per 100,000 person years” means that if 100,000 people under the age of 65 were followed for a year, 20 of those people died of a premature heart attack.
Health Inequities Rooted in Racist and Discriminatory Policies and Practices
“These trends highlight distinct healthcare disparities among people from diverse racial and ethnic backgrounds,” Khan said in the release. “For example, low socioeconomic status, higher prevalence of having no health insurance, and higher prevalence of cardiovascular risk factors, such as smoking, hyperlipidemia, type 2 diabetes, and high blood pressure, among racial [or] ethnic minorities — all of these factors widened the health gap for people from diverse racial and ethnic groups,” he said. “Individuals living within areas deemed to be ‘socially vulnerable,’ characterized by low socioeconomic status, low education, high unemployment, and low access to reliable transportation, experience disproportionately more risk factors for poor health that contribute not only to a higher risk for cardiovascular diseases, but for all-cause premature death,” says Megan Irby, PhD, a professor at the school of health and human sciences at the University of North Carolina Greensboro and senior research associate at the Maya Angelou Center for Health Equity at the Wake Forest School of Medicine in Winston Salem, North Carolina. “Poverty, low education, and rural and urban location help explain the persistence of health disparities, but they are byproducts rather than the primary culprits of the problem,” says Dr. Irby. These inequities can be traced back to their roots in racist and discriminatory policies and actions at both local and national levels that have been woven into the fabric of U.S. society, she says.
Risk Factors for Having a Heart Attack at a Young Age
Only about 0.3 percent of adults under 40 experience a heart attack, but that represents an increase of about 2 percent a year for the last 10 years, according to research presented at the 2019 American College of Cardiology Annual Scientific Session. There are a few important risk factors of having a heart attack at a young age, according to Hackensack Meridian Health.
Substance abuse or excessive alcohol useSmokingHigh blood pressureHigh cholesterol levelsLack of physical activityDiabetesPoor diet
