In the battle for equality between the sexes, it seems women are on the verge of overtaking men in one area – but this is a gain no one wants. According to a study published in the journal Circulation in February 2019, young women are more likely to be hospitalized for a heart attack than men.

“The proportion of AMI (acute myocardial infarction) hospitalizations attributable to young patients increased from 1995 to 2014 and was especially pronounced among women. History of hypertension and diabetes among young patients admitted with AMI increased over time as well.” – Arora et al., 2019

The study led by Dr. Sameer Arora from the University of North Carolina looked at hospital admission records from 21 different hospitals across four regions in the United States. Between 1995 and 2014 the percentage of patients 35 to 54 years old admitted to hospital for a heart attack increased from 27% to 32%. Much of this increase was attributed to higher rates of hospitalization for women in particular, who saw their rates rise from 21% in 1995 to 31% in 2014. Over the same period, men aged 35 to 54 years old had a much smaller increase from 30% to 33%. Despite the increasing incidence of heart attacks in young women, these patients were less likely to receive appropriate care compared to their male counterparts.

Heart attacks are normally associated with older populations, in particular older men. So why are younger women increasingly at risk of being admitted to the hospital for a heart attack? Dr. Sameer and colleagues note in their study that a definitive answer requires more research, but there are a few possibilities to consider.

Exercising Lifestyle Choices

Even though young adults are not considered to be at high risk for heart attacks, the truth is that cardiovascular disease develops over time. Lifestyle choices including eating habits and exercise routines have profound influence on the risk of cardiovascular disease.

A study published in the journal Pediatrics found that only 9% of high school students met the daily exercise recommendations, and that these low rates continued into adulthood. Physical inactivity in children is not just a problem in the United States. The WHO found that 81% of adolescents worldwide do not meet recommended daily activity levels. Consistent across many studies is the finding that young females are less likely to meet daily exercise recommendations than their male peers. These habits formed early in life may lead to an elevated risk for heart attacks later in life, in particular for women.

It’s Complicated

Diabetes and high blood pressure are chronic conditions that put increased strain on the heart. People with these conditions are much more likely to suffer a heart attack. The Arora study found that across all years of the study, women had higher rates of diabetes and high blood pressure than men of a similar age. Higher rates of these conditions in women is not a unique finding of this study. A recent U.S. study of over 1.4 million adults 18 to 59 years old reported higher rates of diabetes, high blood pressure and obesity in women, but higher rates of lipid disorders in men. Sex differences in these risk factors appeared even in the youngest subgroup of patients aged 18 to 44 years old.

The presence of multiple risk factors like diabetes and high blood pressure in young women may put them at higher risk of complications, forcing higher rates of hospitalization.

Stressed Out

One unique risk factor for heart attacks that was not investigated in the Arora study was social stress. A 2015 Scientific Statement from the American Heart Association noted that psychosocial stressors like poverty, discrimination and mental health issues appear to be associated with an increased risk of cardiovascular disease but that more research is needed. Psychosocial stressors like poverty and discrimination are more common in women and increase the risk of heart attack.

The link between psychosocial stress and cardiovascular disease is supported by a number of studies. A meta-analysis of 40 independent studies found a significant increase in the risk for heart attack with depression. These findings were similar to a study of over 10,000 adults in Stockholm, Sweden which also found an increased risk for ischemic heart disease with depression or anxiety. In the United States a study of 217 Black and 140 Latino Americans showed increased blood pressure shortly after events of perceived racism. Increased blood pressure is a known risk factor for cardiovascular disease, including heart attacks.

“This study found that severity level of depression seems to be of significance for increased risk of CVD among depressed persons, although not in a dose-response manner which might be obscured due to treatment of depression. Further, we found a higher risk of CVD among depressed individuals with symptoms of anxious distress.” – Almas et al., 2015

Why All the Fuss?

The study by Arora and colleagues points to a lack of understanding about the risk of heart attacks young women face. Heart attacks are widely believed to be a health issue faced primarily by men. Young women consider themselves to be at low risk for heart attacks even when they have risk factors like high blood pressure and diabetes. A study published in the Canadian Journal of Cardiology found that up to 78% of women at high risk for a heart attack considered their risk to be low.

It’s not just young women who lack an understanding about their risk of heart attacks. Only 22% of primary care physicians and 42% of cardiologists consider themselves to be extremely well prepared to diagnose and treat women. Less than 1 in 5 physicians follow guidelines for assessing cardiovascular disease risk in women.

Where Do We Go?

In order to tackle this growing health problem, educational efforts are needed. Campaigns by the Heart and Stroke Foundation of Canada and the American Heart Association have drawn attention to the risk of heart attacks in women. The overwhelming majority of physicians feel these educational campaigns are helpful for themselves and their patients. Despite these efforts, there is still a long way to go.

Risk factors like poor diet and a lack of exercise are established early in life. Informing young girls of these risks is critical to establishing healthy choices and decreasing the chance of a heart attack later in life.

Physicians and healthcare providers should be educated on the risk of heart attacks in young women and not automatically consider them as low risk. Young women typically have higher rates of other conditions like diabetes and high blood pressure which may complicate the treatment of heart attacks. Sex-specific treatment guidelines must be considered to treat this unique population of patients.

In short, heart attacks in women need to be seen for what they are: a significant health threat to women that requires a tailored approach from diagnosis to treatment.

Have questions about your heart disease risk and what you can do about it? Ask questions in the comments below, and also check out resources from the American Heart Association. Learn more about your risks here.