Lackluster AMI rates in middle-age adults reveal gaps

Between 2001 and 2010, some acute MI (AMI) rates barely budged for people younger than 55, a trend that runs counter to the declines reported by Medicare in elderly patients, according to a study published July 29 in the Journal of the American College of Cardiology.

Strides have been made toward improving AMI survivorship in young women, but apparently not enough, according to the research team lead by Aakriti Gupta, MBBS, of Yale-New Haven Hospital in Connecticut, particularly when it comes to racial disparities.

Patient information from the Nationwide Inpatient Sample was used to break 230,684 hospitalizations into five age groups ranging from 30 to 54 years of age. These groups were further analyzed based on race and sex.

Approximately one-fourth of the patients were female. Black women comprised 19.7 percent of patients, while black men comprised 10.5 percent. More men were hospitalized than women overall; however, between 2001 and 2010, women increased their total hospitalizations, from 56 per 100,000 to 61 per 100,000.

Black women consistently had more hospitalizations than white women, even when analyzing across age groups, growing more noticeable the older patients became. Notably, in the 50 to 54 age group, black women had approximately 250 per 100,000 AMI hospitalizations while white women had approximately 150 per 100,000 AMI hospitalizations across the 10-year span.

In-hospital mortality rates declined in total, but not significantly in men (2 percent to 1.8 percent). Women saw a decline from 3.3 percent to 2.3 percent, but they still had a higher mortality rate than men. Women also had longer hospital stays across all age groups.

When comparing these trends with Medicare data on older patients, Gupta et al posited that education of risk factors for cardiovascular disease may not be reaching younger, more diverse patients early enough to influence outcomes or may be related to genetic factors.

“This trend suggests we need to raise awareness of the importance of controlling cardiovascular risk factors like diabetes, high blood pressure and smoking in younger patients,” said Gupta in a press release.

The question then becomes how best to go about it.

Leslee J. Shaw, PhD, and Javed Butler, MD, MPH, of Emory University School of Medicine in Atlanta remarked in an editorial that risk-based calculators are not as effective in categorizing risks for black women, which highlights inadequacy in approaches to prevention. “[T]he higher rate of AMI hospitalization combined with the risk factor burden suggests that primary prevention efforts are less effective for young black female patients.”

Gupta et al and Shaw and Butler recommended re-examining how best to effectively reach women, particularly black women, about modifiable risk factors, including diabetes, smoking, high cholesterol, obesity and high blood pressure.

“Younger women are a vulnerable yet understudied group with worse cardiac risk profiles and worse outcomes after a heart attack as compared with younger men,” Gupta said, suggesting that early identification and more aggressive treatment may be the key to improving outcomes in younger patients.