CHD Mortality Decreasing Overall But Has 'Stagnated' in Younger Adults, Women

Deborah Brauser

August 24, 2015

ATLANTA, GA – In a case of good news, bad news, a new study funded by the National Institutes of Health (NIH) reports that while mortality rates for coronary heart disease (CHD) in US adults over the age of 65 decreased consistently from 1979 through 2011, rates for adults younger than 55, especially women, were not so rosy[1].

The analysis of US National Vital Statistics data showed that CHD mortality for those age 55 years and under decreased steadily between 1979 and 1989, but then plateaued. Men in this age group had a decrease of 5.5% over 1979 to 1989, which fell to just 1.8% between 2000 and 2011.

For the women in this younger group, CHD mortality declined by 4.6% between 1979 and 1989, showed no improvement during the next decade, and then decreased by only 1% from 2000 until the study's end.

"The dramatic decline in CHD mortality since 1979 conceals major heterogeneities," write the investigators, led by Dr Kobina A Wilmot (Emory University School of Medicine, Atlanta, GA).

They add that in recent decades, "CHD prevention guidelines may disproportionately underestimate risk in the young population, undermining prevention efforts," possibly because of less traditional risk factor patterns.

The findings were published online August 24, 2014 in Circulation.

Drilling Down Into the Data

A study published in 2007 showed that, from 1980 to 2002, CHD mortality rates decreased by 52% in men and 49% in women[2].

For the updated analysis, researchers wanted to also examine recent trends among young women and men. They assessed data for all individuals at least 25 years of age between 1979 and 2011, focused on CHD mortality rates, and estimated annual percentage changes over the entire study period and three time spans: 1979 to 1989, 1990 to 1999, and 2000 to 2011.

Age-adjusted CHD mortality declined from 1979 to 2011 by 68% in both men (down from 703 to 225 deaths per 100,000) and women (down from 395 to 125 deaths per 100,000).

Until 1990, those younger than 55 years showed substantial decreases in CHD mortality. "However, the two subsequent decades saw stagnation with minimal improvement," write the investigators, adding that "the causes of the sluggish improvements" are unclear.

They note that "contrary to common perception," roughly 22% of all ACS hospital admissions are for those younger than 55 years. Also, approximately 25% of all hospitalizations for acute MI are for women.

"The drivers of these major differences in CHD mortality trends by age and sex merit urgent study," write the researchers.

Looking Behind the Curtain

"These new findings highlight the value of looking 'behind the curtain' at health data," writes Dr Elizabeth G Nabel (Brigham and Women’s Health Care, Boston, MA) in an accompanying editorial[3].

The overall decline in age-adjusted CHD mortality found in the study "is nothing short of remarkable and validates progressive improvements in CVD prevention and treatment," adds Nabel. However, she calls the subpopulation results "troubling."

She notes that reasons for these plateauing mortality rates could be because most studies focus on older individuals—and because women are commonly underrepresented.

Moving forward, Nabel recommends ongoing CVD screenings in both women and men over age of 25 years across several specialties. For women, that could include primary-care physicians, gynecologists, and obstetricians.

In addition, "specialists such as endocrinologists can play an important role in CVD diagnosis and treatment by considering comorbidities such as diabetes, which has risen dramatically in young women over the past few decades along with a concomitant increase in overweight and obesity."

Other recommendations include pursuing new CVD prevention and treatment options, conducting more research on CVD mechanisms in all age, sex, and race populations, and practicing personalized medicine.

Overall, she notes that the field is at a crossroads and facing considerable work that demands a refocusing of efforts. "The promise of a life free from CVD should be within reach of all Americans," concludes Nabel.

The study was funded by grants from the NIH. Study authors and Nabel have reported no relevant financial relationships.

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