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Why Are Heart Disease Deaths Rising in Women Under 65?

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Key Takeaways

  • Globally and in the U.S., heart disease is the leading cause of death.
  • A recent study found that death rates from heart disease are increasing in young women.
  • Experts believe this may be due to a sedentary lifestyle and poor diet choices, which can lead to heart disease risk factors like diabetes, hypertension, and high cholesterol.

Heart disease is the main cause of death worldwide, and age is a risk factor we can't do anything about, but a recent study found increasing death rates from heart disease in younger women (under age 65).

Published in European Heart Journal – Quality of Care and Clinical Outcomes, a journal of the European Society of Cardiology, the study found that heart disease death rates have been rising since 2010.

A team of researchers from across the U.S. analyzed death certificates between 1999 and 2018 from a national database to compare heart disease- and cancer-related deaths in women under 65. Across the entire study period, age-adjusted mortality rates decreased for both cancer and heart disease.

But while cancer death rates showed a consistent downturn throughout the 19 years, heart disease death rates fell initially, then increased between 2010 and 2018. As a result, the absolute mortality gap between cancer and heart disease significantly decreased from 32.7 to 23.0 per 100,000/year.

Victoria Shin, MD

The rising incidence of obesity and the metabolic ailments that arise from it (e.g. diabetes mellitus hypercholesterolemia, hypertension, etc.) is likely driving the increase in heart disease amongst the younger population.

— Victoria Shin, MD

The study authors said: “If extreme public health measures are not taken to mitigate cardiovascular risk factors, focusing on high-risk groups, heart disease mortality may supersede cancer to become the leading cause of death in young women.”

Why Is Heart Disease Rising in Young Women? 

“The rising incidence of obesity and the metabolic ailments that arise from it (e.g. diabetes mellitus hypercholesterolemia, hypertension, etc.) is likely driving the increase in heart disease amongst the younger population,” says Victoria Shin, MD, interventional cardiologist with Torrance Memorial Medical Center in Torrance, California.The modern sedentary lifestyle and diet may result in obesity which, in turn, often lead to diabetes, hypertension, high cholesterol—all the traditional risk factors that cause heart disease.” 

Victoria Shin, MD

The modern sedentary lifestyle and diet may result in obesity which, in turn, often lead to diabetes, hypertension, high cholesterol – all the traditional risk factors that cause heart disease.

— Victoria Shin, MD

We also live in a stressful, fast-paced world, and more and more women are making poor lifestyle choices as they try to juggle family responsibilities and workplace demands, says Aventura, Florida cardiologist Leonard Pianko, MD.

That might mean women aren’t eating properly or sleeping enough, because the demands on them are so high and they’re prioritizing others’ needs before their own.

“Women are also fighting bias in the physician's office where their symptoms are often dismissed as anxiety,” Dr. Pianko adds.

Warning Signs of Heart Attack 

In both men and women, the most common heart attack symptom is chest discomfort. But women also present with atypical symptoms such as shortness of breath, nausea, sweating, fatigue, and discomfort in the neck or jaw,

“Prior to an actual heart attack, patients typically complain of chest pain or shortness of breath,” Dr. Shin says. “Women often have more vague symptoms of decrease in exercise tolerance and fatigue.”

This is because women have smaller blood vessels than men, so their symptoms are different and much broader, Dr. Pianko explains.

Both men and women can have a heart attack without any prior symptoms—what's often referred to as a silent heart attack.

Victoria Shin, MD

Prior to an actual heart attack, patients typically complain of chest pain or shortness of breath. Women often have more vague symptoms of decrease in exercise tolerance and fatigue.

— Victoria Shin, MD

Addressing the Issue 

The researchers believe that “intensive cardiovascular interventions” are required to curb the rising rates of heart disease in young women and other populations, and Dr. Shin agrees.

“Heart disease is still the number one killer in the U.S. for both men and women,” she says. But it can be a challenge to convince patients to take medications or make lifestyle changes to prevent something that hasn’t happened yet, when they “feel fine.”

“Women are usually more compliant with getting mammograms and following up with recommendations when an abnormality is detected because it is much more tangible,” Dr. Shin explains. “On the other hand, the risk factors that take years to result in heart disease—hypertension, cholesterol, diabetes—are, for the most part, silent.”

Leonard Pianko, MD

Women need to be active participants in their own health and take better care of themselves. Traditionally, women put their own health needs as a low priority, and it's time for them to focus on the signals their bodies are sending them.

— Leonard Pianko, MD

Doctors try to emphasize these “silent killers” because many people won't have symptoms until they actually have an event such as a heart attack, stroke, or heart failure, Dr. Shin adds.

“We have to make a concerted public health effort to educate people on the importance of preventing heart disease—that the things they do on a daily basis (e.g. the medications with which they are compliant, the healthy food choices they make, the daily exercise they schedule) all contribute to reducing the risk of heart disease,” Dr. Shin says. “It's not a one and done thing like getting a fracture repaired or removing a breast lump.”

Dr. Pianko describes the recent study as “a wake-up call for women of all ages and their physicians.”

“Women need to be active participants in their own health and take better care of themselves,” he warns. “Traditionally, women put their own health needs as a low priority, and it's time for them to focus on the signals their bodies are sending them. They should be watching their diet, exercising more, finding ways to decrease the stress in their lives, and making sure their doctor is actively listening to the information they are sharing.”

What This Means For You

It's never too early to start thinking about heart health. The American Heart Association has an interactive online tool called My Life Check, which can help you track your heart health information and understand your risk of heart disease and stroke.

Things you can do to reduce your risk of heart disease include managing your blood pressure, reducing your blood sugar, leading a more active lifestyle, maintaining a healthy weight, and stopping smoking. If you need help, your doctor can provide advice and resources.

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  1. Khan S et al. A comparative analysis of premature heart disease- and cancer-related mortality in women in the USA, 1999–2018. European Heart Journal – Quality of Care and Clinical Outcomes. 2021 Feb. doi:10.1093/ehjqcco/qcaa099