Although overall deaths from coronary heart disease (CHD) have declined during the past few decades, mortality in younger women has declined minimally, according to the American Heart Association (AHA).

Viola Vaccarino, MD, PhD, of the Rollins School of Public Health in Atlanta, Georgia, and colleagues examined mortality data from individuals aged 25 years or older in the United States between 1979 and 2011, and stratified the data into three periods: 1979-1989, 1990-1999, and 2000-2011. They calculated age-specific CHD mortality rates and compared the annual percentage changes, which revealed the stagnated decline of CHD in young women. The findings were published in Circulation.

From 1979 to 1989, mortality among those aged 55 years and younger declined 5.5% in men and 4.6% in women. During the next 2 decades, however, the decline slowed significantly. The death rate for men fell 1.2% from 1990 to 1999 and an additional 1.8% since 2000. For women there was no improvement from 1990 to 1999 and only a decline of 1% since 2000.

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Although there has been less improvement in CHD mortality among young women, the disparities between men in women have narrowed during the last decade. “We think that these trends are not related to differences in treatment and hospitalization, but rather to a lack of effective preventive strategies for young people, particularly women,” Dr. Vaccarino said during a press release.

Young women are considered at low risk for CHD, and are not studied as much as the other age groups. The study suggested that researchers must look beyond the traditional risk factors like high blood pressure and cholesterol to improve CHD prevention guidelines and protect heart health in adults aged 55 years and younger.

However, the CHD mortality rate in adults aged 65 years or older showed consistent decline since 2000, decreasing 5% in men and 4.4% in women. “The marked decline in CHD mortality among older adults may partly represent a cohort effect,” the authors wrote. “For example, improved risk factor control or other preventive measures in middle age may have resulted in declining CHD mortality at older age.”

Women aged 55 years and younger show less traditional risk factor patterns for CHD. Obesity and psychosocial factors may play a bigger role in CHD for young women than adults aged 65 years and older. Recent data indicate that metabolic syndrome and diabetes are higher in young women, both of which increase the risk of acute MI. In fact, young- and middle-aged women with diabetes experience a 4- to 5-fold increased risk of incident CHD compared with those without diabetes—a much higher risk than men of a similar age. Depression and perceived stress are especially common in young women, and these can increase the risks of CHD hospitalizations and can delay recovery after a cardiac event.

The researchers conclude that further investigation is required to determine new risk factors in younger populations to establish adequate prevention strategies for CHD.


  1. Wilmot KA, Flaherty MO, Capewell S, Ford ES, Vaccarino V. Coronary Heart Disease Mortality Declines in the United States From 1979 Through 2011: Evidence for Stagnation in Young Adults, Especially Women. Circulation. 2015;doi:10.1161/circulationaha.115.015293.