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CHD mortality rate trends slowing among young women
Negative-trending data for both sexes raise concerns about reversing years of progress.
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Although overall mortality rates continue to decline nationally, data conceal negative trends in the coronary heart disease mortality rate that have been developing slowly for the last decade.
Using CDC data, the researchers examined CHD mortality rates between 1980 and 2002. Although the overall age-adjusted mortality rate was 52% in men and 49% in women, the mortality rate of women aged 35 to 54 years has crept up from previous levels by an average of 1.3% (95% CI, 0.2-2.5) since 1997. Results of the analysis were published in the Journal of the American College of Cardiology.
Negative trends continue
The mortality rate among women aged 35 to 54 years has only recently been positive, but it has been trending in a negative direction since 1980. Between 1980 and 1989, the rate was –5.4% (95% CI, –5.8 to –4.9%), –1.2% (95% CI, –1.6 to –0.8) between 1989 and 2000 and 1.5% (95% CI, –3.4 to 6.6) between 2000 and 2002.
Even though the mortality rates for men aged 35 to 54 years were not as high as the rate for women the same age, the rates have also been trending in the wrong direction since 1980, dropping from –6.2% (95% CI, –6.4 to –5.9) between 1980 and 1989 down to –0.5% (95% CI, –3.7 to 2.9) between 2000 and 2002.
According to the researchers, the unfavorable trends have correlated with a steady increase in the prevalence of CHD risk factors like abdominal obesity, diabetes and hypertension. These trends have occurred despite widespread use of evidence-based therapies like statins, angioplasties and ACE inhibitors.
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“If you put that together with other studies saying that most of the decline in the CHD mortality was due to changes in risk factors, it would be reasonable to speculate that an increase in risk factors would affect those mortality rates,” Rita Redberg, MD, professor of medicine at the University of California, San Francisco, and a member of the Preventive Cardiology section of the Cardiology Today editorial board, said in an interview. “Certainly, the obesity epidemic and all of the increased risk factors that go with it like diabetes and hypercholesterolemia could be responsible for that slowing in the decline in the mortality rate.”
Although the data are not uniformly negative and still manage to demonstrate a decreasing mortality rate overall for most patient populations, the slowing trends in these patient subsets are enough to prompt discussion over the best course of action for reversing them. The researchers offered suggestions, which included vigorous monitoring and screening at young ages, diet control, governmental legislation and alteration of risky behaviors like sedentary lifestyles and poor diet.
“There was also the Copenhagen City study that was recently published that I thought was a good study,” Redberg said. “Any study that concludes you should drink moderately and exercise frequently is a good study.” - by Eric Raible
We have to seriously pose the hypothesis that risk factors are going up for everyone. The adverse outcomes in women have historically been due to a lack of awareness, a lack of treatment and a lack of understanding of diagnosis and treatment of ischemic heart disease in women. If you are going to determine who is going to fall under the radar the most for awareness, detection and treatment, it is going to be relatively young women. Somehow, people still labor under the idea that because young women get heart disease at a relatively lower rate compared with young men, it means that they never get it. Consequently, they are not evaluated for signs or symptoms, they are not provided with life-saving therapy and then suffer the adverse consequences.
— C. Noel Bairey Merz, MD
Cardiology Today Editorial Board member
For more information:
- Ford E, Capewell S. Coronary heart disease mortality among young adults in the U.S. from 1980 through 2002. J Am Coll Cardiol. 2007;50:2128-2132.