Heart Attack Deaths Rose 1.2 Percentage Points Among Adults Under 55 Between 2011 and 2022

Heart disease has long been framed as a problem of older age - something that happens to men in their 60s, a risk that climbs gradually over decades of accumulated exposure to high blood pressure, elevated cholesterol, and sedentary living. That framing was never entirely accurate, and according to a large analysis published in the Journal of the American Heart Association, it is becoming less accurate over time.

The study examined U.S. hospital data from 2011 to 2022, tracking in-hospital deaths after first hospitalization for severe heart attacks among adults ages 18 to 54. The number of deaths in this age group increased significantly over the study period. The absolute increase was 1.2 percentage points - modest in isolation, but set against a background where advances in cardiac care were expected to be pushing mortality in the opposite direction.

Women dying more often than men

Across the eleven-year period, women under 55 had higher in-hospital death rates than men of the same age following a first heart attack. This was true for both major types: STEMI (ST-elevation myocardial infarction, caused by a complete blockage of a coronary artery) and NSTEMI (non-ST-elevation myocardial infarction, resulting from a partial blockage). The sex difference persisted after statistical adjustment for a broad range of risk factors.

The disparity in outcomes between younger women and men after heart attacks is not a new observation - it has been documented in previous studies and attributed to multiple factors including differences in how symptoms present, potential differences in how urgently women's symptoms are assessed, and biological differences in vascular anatomy and response to treatment. This study adds to that body of evidence with data spanning more than a decade of contemporary practice.

Nontraditional risk factors dominate

The most analytically significant finding concerns which risk factors are driving the mortality trend. After accounting for all assessed risk factors, heart attack deaths in this age group were more strongly linked to what the researchers call nontraditional risk factors than to traditional cardiovascular risk factors.

Traditional risk factors - high blood pressure, high cholesterol, diabetes, smoking, obesity - are the standard targets of both prevention programs and clinical risk assessment tools like the Framingham Risk Score. These tools were largely designed using data from older populations where traditional risk factors dominate the risk picture.

In the under-55 population studied here, low income, chronic kidney disease, and non-tobacco drug use emerged as more strongly associated with in-hospital mortality than the traditional risk factors. Women also had a higher burden of these nontraditional risk factors than men in the study population, which may help explain part of the sex difference in outcomes.

What this means for risk assessment

Standard cardiovascular risk assessment tools are not designed to capture these factors systematically. Low income is rarely collected in clinical settings, kidney disease may not be assessed in younger patients without apparent renal symptoms, and drug use is often underreported or not asked about in cardiac risk evaluations.

The study's authors argue that improving risk assessments to include nontraditional factors could help identify younger adults at elevated risk of dying from a heart attack - before the heart attack occurs - and could inform more targeted prevention and early intervention strategies. Specific numbers are important here: a 1.2 percentage point absolute increase in mortality over eleven years, in a population that was supposed to be benefiting from improving cardiac care, represents a meaningful and unexpected trend.

The limits of a hospital-based analysis

The study tracks in-hospital deaths after first hospitalization for severe heart attacks - it does not capture people who died before reaching the hospital, which is a substantial portion of heart attack deaths overall and may differ systematically from in-hospital deaths in ways that affect interpretation. The data sources are administrative hospital records, which are subject to coding variability across institutions and over time.

The analysis also cannot fully account for changes over the study period in who gets hospitalized for heart attacks, how heart attacks are diagnosed and classified, or how care quality varies across institutions serving populations with different socioeconomic profiles. These factors complicate direct year-to-year comparisons.

What the data do establish clearly is a trend in the wrong direction, concentrated in a demographic where cardiac events were historically assumed to be rare and preventable, and driven by risk factors that standard clinical tools are not designed to assess.