Heart attack hospitalization rates among young and middle-aged adults have remained stable during the previous decade, even as seniors of Medicare age experienced a better than 20 percent decline in heart attacks, the Yale University researchers found.
"We know overall the rates of heart attack for the whole U.S. population have been declining due to prevention efforts and treatment efforts. But there is this emerging data that the benefits have not been experienced by all groups of patients," said Dr. Gregg Fonarow, co-director of the UCLA Preventative Cardiology program and a spokesman for the American Heart Association.
Women, in particular, often don't fare well after a heart attack, the researchers found. They are more likely than men across all age groups to die while receiving hospital treatment for a heart attack, and they also take longer to recuperate from a heart attack.
The study authors said women aged 30 to 54 are more likely to fare worse from heart attacks than men because they tend to have more health problems that can lead to heart attacks, such as high blood pressure, heart failure, kidney disease and diabetes.
"We should redirect our resources for primary heart attack prevention toward young women," said study lead author Dr. Aakriti Gupta, a researcher at Yale University School of Medicine's Center for Outcomes Research and Evaluation. "We need to pick up high blood pressure and diabetes in these young women early and treat it aggressively."
To draw their conclusions, the Yale researchers reviewed records of nearly 231,000 hospitalizations for heart attacks in patients 30 to 54, out of a total 1.1 million hospitalizations between 2001 and 2010 reported in a national database.
They found that, overall, men and women aged 30 to 54 landed in the hospital for heart attacks about as often at the end of the decade as they did at its start.
Obesity and diabetes among younger adults appear to be overwhelming the improvements in treating high blood pressure and high cholesterol that have helped older Americans reduce their heart attack risk, Fonarow said.
"What would have been potentially large reductions in heart attacks across the board for all age groups have not completely emerged because of these offsetting risks that have really taken off," he said. "The rates of diabetes and obesity among young people have dramatically taken off over the last 20 years, to a point that some would call epidemic levels."
Even though women accounted for a quarter of younger adults hospitalized for heart attack, they were more likely to die from their heart attack and to stay longer in a hospital afterward, the Yale researchers reported.
Black women, in particular, proved very vulnerable, Gupta said. They consistently had much higher hospitalization rates than white women, while there was little difference between black and white men.
Delays in recognizing signs of a heart attack in a younger woman likely cause greater damage and death, Fonarow noted.
"Someone looks at this 30- or 40-year-old female -- they can't be having a heart attack, so it must be something else," Fonarow said. Women end up getting less aggressive treatment because it takes longer to detect their heart attack, he suggested.
Even younger women themselves don't recognize their heart attack risk, Gupta said.
"Young women don't know they are at increased risk of heart attack, because that's [misperceived as] a disease of old men," she said. "They don't seek care as much."
Because of that, younger women also are less likely to seek treatment for problems such as high cholesterol or high blood pressure that can lead to heart attacks, Gupta said.
The new study should serve as a wake-up call for both patients and doctors, Fonarow said.
"People should realize risks can begin early, and there are younger people who will have heart attacks," he said. "Prevention is key, and if symptoms develop immediate attention is necessary."
The study appears in the July 29 issue of the Journal of the American College of Cardiology.
For more on women and heart disease, visit the U.S. Centers for Disease Control and Prevention.
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