Circulation | 2019
Myocardial Infarction in Young Women: An Unrecognized and Unexplained Epidemic
Abstract
There has been considerable progress in the prevention and treatment of coronary heart disease in the United States and other Western nations over the past 40 years, with substantial declines in heart disease mortality. However, concern has been raised that young adults, and young women in particular, may have benefited less from these favorable trends in recent years. Heart disease mortality rates have declined less in this group than in other segments of the population since 1990,1 and studies both in the United States and in other developed nations have reported rising hospitalization rates for myocardial infarction (MI) in younger women.2–4 The prehospital case fatality of MI has similarly declined less in young women than in men.5 These recent statistics have raised alarm and require possible explanations.6 However, much of the available data regarding time trends in coronary heart disease come from mortality statistics and administrative databases, which can be incomplete and inaccurate. In this issue of Circulation, Arora et al,7 using data from the ARIC (Atherosclerosis Risk in Communities) surveillance study, examined trends in the incidence and management of MI for the period between 1995 and 2014, with a focus on young adults. The authors analyzed surveillance data in the 4 US ARIC communities, which allowed the examination of incident MI based on adjudicated events rather than a reliance on hospital billing codes. To collect these data, the ARIC surveillance study abstracted and reviewed more than 15 000 medical records. The authors report a staggering increase in the annual incidence of hospitalized MI among young women (35–54 years old), whereas the incidence decreased among men in the same age bracket. During the study period, the percentage of women and men who were 35 to 54 years old declined relative to the total population. Despite the increased proportion of older patients in the surveilled population, the proportion of MI admissions for young women (35–54 years old) increased, from 21% in 1995 to 1999 to 31% in 2010 to 2014, while it remained relatively stable among young men (from 30% to 33%). When examined by race, the proportion of MI admissions occurring in the young population increased by 41% in white women and by 19% in black women, whereas it did not significantly change among men of either race. Although this study did not provide data on people who were older than 54 years, the increasing proportion of incident MI in young adults implies a parallel declining incidence in older groups, which is consistent with reports from other developed countries.2,4,8 What explains these worrisome trends for women? Young women with MI were more likely than their male counterparts to have comorbidities, including hypertension, diabetes mellitus, chronic kidney disease, and prior stroke, but they were less likely to smoke and more likely to have medical insurance. They also more often © 2019 American Heart Association, Inc.