News:Coronary heart disease mortality in young women makes the headline news

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November 21, 2007 By Benjamin A. Olenchock, M.D. Ph.D. [1]

Coronary heart disease (CHD) mortality in young women is making the headline news this week. ABC reports that “Heart disease kills more women under 45” while CBS reports that “More young women dying of heart disease”. Dr. Philip Greenland, who wrote an accompanying editorial to the article, told Reuters that this study “should be regarded as a wake-up call for everyone interested in heart disease and heart health.” Research from the Centers for Disease Control and Prevention published in the Journal of the American College of Cardiology suggests that mortality rates from CHD are on the rise in women aged 35-54.

The authors used United States vital statistics to examine death rates from CHD from 1980 to 2002. The results were quite encouraging: age-adjusted mortality rates from CHD continue to decline in a linear fashion. Death rates have decreased 52% in men and 49% in women over this time interval. In every age category, death rates in women are lower than death rates in men. This study focused on change in death rates per year, and absolute death rates are not provided in the publication. Looking at the graphical data, however, one can estimate that death rates from CHD in men age 35-44 is near 25 per 100,000 population, while that number is less than 10 per 100,000 in women of that age group.

In every age category of men ages 35 and older, significant decreases in CHD mortality have been achieved since 1980. For women, the largest gains have been in the oldest age groups. For young women (age 35-44), the mortality rate since 1980 is almost a flat line – mortality rates were near 10 per 100,000 population in 1980 and remain there near that number in 2002.

The focus of the current media attention is the author’s nuanced examination of death rate changes within shorter periods of time. Focusing again on women age 35-44, the authors note that CHD death rates have increased by 1.3 % (CI 0.2% to 2.5%) per year since 1997. Again, absolute numbers are not readily available, but looking at the graphical data this would correspond to an increase from near 8 per 100,000 population to 9 per 100,000 population. In women aged 35 to 54, the death rate from CHD decreased by 5.4% (CI –5.8% to –4.9%) in the 1980s, decreased 1.2% (CI –1.6 to –0.8) in the 1990s, and did not change (point estimate 1.5% increase; CI –3.4% to 6.6%) between 2000 and 2002. In men age 35-54, death rates decreased by 6.2% (CI –6.4% to –5.9%) in the 1980s, decreased by 2.3% (CI –2.6% to –2.1%) in the 1990s, did not change (point estimate 0.5% decrease; CI –3.7 to 2.9) between 2000 and 2002.

Focusing on CHD mortality in younger Americans, the data demonstrate that there continues to be higher mortality in young men than in young women. In both men and women, mortality rates appear to be leveling off in recent years, preserving the gender differences. The death rates in women age 35-44 is the lowest of any age / gender category, is similar to the rate in 1980, but since 1997 there has been a statistically significant trend towards increased rate of death, with an absolute increase in mortality estimated at 1 death per 100,000 population.

This study is an important "wake-up call", and attention should focus on disease awareness and modification of heart disease risk factors including smoking cessation, treatment of hypertension and elevated cholesterol, weight loss, and exercise. These lessons are equally important for young men and young women.

1. Coronary Heart Disease Mortality Among Young Adults in the U.S. From 1980 Through 2002: Concealed Leveling of Mortality Rates. Earl S. Ford and Simon Capewell. JACC, In Press, Corrected Proof Available online 13 November 2007