Are Heart Attacks Increasing in Young Women?

Written by Dr. Steve Chaney on . Posted in Heart Attacks in Women

Why Are Heart Attacks Increasing In Young Women?

Author: Dr. Stephen Chaney

 

are heart attacks increasing in young women age 32-54Heart disease is still the leading cause of death in the United States, but things seemed to be getting better. More people are following heart-healthy diets and the treatment of heart disease has improved. One recent study found that the overall rate of heart disease has decreased by 38% in the U.S. since 1990. Heart attack rates have also been inching down in recent years.

Are heart attacks increasing in young women?

That’s why the latest study was both surprising and concerning. If it is to be believed, heart attack rates are increasing in young Americans, especially young women. That is particularly shocking because young women are thought to be protected from heart disease by their estrogen. Until recently, heart attack rates have been lower for young women than for young men. It hasn’t been until after menopause that women caught up to men in terms of their risk for a heart attack.

Obviously, this study raises several questions:

  • Is it true?
  • Why are heart attacks increasing in young women?
  • What should young women be doing to prevent heart disease?

 

How Was The Study Done?

heart attacksThis study (S Arora et al, Circulation, 139: 1046-1056, 2019 was an offshoot of the Atherosclerosis Risk in Communities (ARIC) Surveillance Study. The ARIC study collected data on hospital admissions for acute myocardial infarction (or in layman terms, heart attacks) for patients aged 35-74 in four geographical areas in the U.S. (Forsyth County in North Carolina, Washington County, Maryland, Jackson, Mississippi, and the Northwest suburbs of Minneapolis, Minnesota).

During the time period of 1995 to 2014 28,732 people ages 35-74 were admitted to one of the participating hospitals for a heart attack. The results of the original study have been published previously (WD Rosamond et al, Circulation, 125: 1848-1857, 2012 ). For the population as a whole:

  • The annual rate of hospital admissions for a heart attack decreased by around 3.5% during this time period, and…
  • The annual rate of death following a heart attack decreased by around 3%.

However, the current study focuses on the younger people in the study (ages 35-54) and came to a surprisingly different conclusion. Contrary to the results obtained with the general population, the rate of heart attacks increased in younger people.

 

What Did The Study Show?

are heart attacks increasing in young women studyAlthough the article uses the terms “young adults” and “young women,” I realize that some of you may consider that misleading. My only comment is whether you consider the 35-54 age range to be “young” or not probably depends on which side of 35 you are on.

Having said that, when the authors compared younger people in the study (the 35-54 age group) with everyone in the 35-74 age group they found:

  • The overall proportion of hospitalizations for heart attack among young people increased from 27% in 1995 to 32% in 2014.
  • The increase in heart attack rate was most dramatic for young women.
  • Hospitalizations for heart attack increased from 30% to 33% for young men. This increase was non-significant.
  • Hospitalizations for heart attack increased from 21% to 31% for young women. This increase was highly significant.
  • This is a wake-up call. We now appear to be entering an era in which heart attack rates for young women (ages 35-54) equal those of young men. The protective effects of estrogen have disappeared.

 

Why Are Heart Attacks Increasing In Young Women?

 

are heart attacks increasing in young women obesityAs I said at the beginning, there are several questions we need to answer:

  • Is this study true? There are some limitations to this study, but it is a fairly robust study. A similar study in Canada came to the same conclusion, and several other studies have suggested a similar trend. More research is needed, but this is a very disturbing finding.
  • Why are heart attacks increasing in young women? The short answer to this question is that we don’t know. However, the study offers several hints.
  • Hospitalizations for heart attack were highly correlated with a history of high blood pressure and diabetes. Obesity was not measured in this study, but it increases the risk of both high blood pressure and diabetes. Experts have been warning for years that the obesity epidemic may undo all the progress we have made at reducing heart disease deaths. This study may be the first indication that the prediction is coming true.
  • Young women were less likely than young men to be receiving lipid-lowering medications and other medications to reduce heart disease risk at the time of admission for their first heart attack. This may reflect a perception among both patients and physicians that young women are less likely to develop heart disease than young men.
  • Young women may be less likely to seek medical advice about how to control obesity, high blood pressure and diabetes, and medical professionals may not treat these conditions as aggressively as they do for young men.
  • The current study suggests the perception that obesity, high blood pressure and diabetes are less likely to cause heart attacks in young women than in young men is no longer true, if it ever was.
  • The early symptoms of a heart attack are different for women than for men. For men heart attacks are associated with chest pain. For women early symptoms of an impending heart attack may be back pain, nausea, or dizziness. Both women and their doctors may not recognize these symptoms early enough to fend off a full-blown heart attack.
  • What should young women be doing to prevent heart disease? This is the topic of the next section.

What Should Every Woman Know About Heart Disease?

 

what every woman should know about heart diseaseThere are several simple lessons every woman should take from this and similar studies.

  • Heart disease is not a male disease. If that were ever true, it is definitely no longer true.
  • Don’t assume your risk is low until you reach menopause. This study suggests today’s young woman is just as likely to have a heart attack as a young man.
  • Obesity, high blood pressure, and diabetes are killers. The good news is that if you start while you are young, you can reverse these killers with diet and lifestyle changes.
  • A heart healthy diet and lifestyle is important at every age. Don’t fall for the diet fads. Despite what Dr. Strangelove’s health blog would have you believe, saturated fats increase your risk of heart disease. A whole-food, primarily plant-based diet is the only proven dietary approach for reducing heart disease risk long term. For more information on how you can protect your heart, read my books. “Slaying The Food Myths” and “Slaying The Supplement Myths”.
  • Get regular checkups. If you develop risk factors for heart disease, don’t ignore them. Treat them aggressively. This requires a partnership between you and your doctor. Your part of the partnership is to make the necessary lifestyle changes to reverse these risk factors. Your doctor’s role is to provide appropriate medications to control these risk factors if you are unable to control them with lifestyle changes alone.

 

The Bottom Line

 

While heart disease has been declining in the general population, a recent study has shown that heart attacks are on the increase for young adults.  In particularly, heart attacks are increasing in young women.

  • The overall proportion of hospitalizations for heart attack among young people increased from 27% in 1995 to 32% in 2014.
  • The increase in heart attack rate was most dramatic for young women.
  • Hospitalizations for heart attack increased from 30% to 33% for young men. This increase was non-significant.
  • Hospitalizations for heart attack increased from 21% to 31% young women. This increase was highly significant.
  • This is a significant and disturbing finding. We now appear to be entering an era in which heart attack rates for young women equal those of young men. The protective effects of estrogen have disappeared.
  • Note: The authors defined 35-54 years old as young. Whether you consider that young or not probably depends on which side of 35 you are on.
  • Hospitalizations for heart attack were highly correlated with a history of high blood pressure and diabetes. Obesity was not measured in this study, but it increases the risk of both high blood pressure and diabetes. Experts have been warning for years that the obesity epidemic may undo all the progress we have made at reducing heart disease deaths. This study may be the first indication that the prediction is coming true.

For more details and my recommendations for what every woman should know about heart disease read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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Latest Article

Are Pregnant Women and Children Dangerously Deficient in Omega-3s?

Posted August 13, 2019 by Dr. Steve Chaney

What Is The Omega-3 Status Of The American Population?

Author: Dr. Stephen Chaney

 

pregnant women omega 3 deficient fishIt is no secret that the American population is deficient in omega-3s. Numerous studies have documented that fact. There are many reasons for Americans’ low intake of omega-3s:

  • The high price of omega-3-rich fish.
  • Concerns about sustainability, heavy metal contamination, and/or PCB contamination of omega-3 rich fish.
  • Misleading headlines claiming that omega-3 supplements are worthless and may even do you harm.

Of course, the questions you are asking are probably?

  • How deficient are we?
  • Does it matter?

The latest study (M Thompson et al, Nutrients, 2019, 11: 177, doi: 10.3390/nu11010177) goes a long way towards answering those important questions.

How Was The Study Done?

scientific studyThis study used data on 45,347 Americans who participated in NHANES surveys between 2003 and 2014. (NHANES or National Health and Nutrition Examination Surveys is a program run by the CDC that is designed to assess the health and nutritional status of adults and children living in the United States).

EPA and DHA intake from foods was based on the average of two 24-hour dietary recall interviews. Trained dietary interviewers collected detailed information on all foods and beverages consumed during the past 24 hours.

To assess EPA and DHA intake from supplements study participants were asked what supplements they had taken in the past 30 days, how many days out of 30 they had taken it, and the amount that was taken on those days.

 

What Is The Omega-3 Status Of The American Population?

 

omega 3 statusThe results of the NHANES surveys were shocking.

In terms of total EPA+DHA intake:

  • EPA+DHA intake across all age groups was lower than recommended.
  • Toddlers (ages 1-5), children (ages 6-11), and adolescents (ages 12-19) had lower EPA+DHA intakes than adults (ages 20-55) and seniors (ages > 55).
  • Women had lower EPA+DHA intakes than men.
  • Pregnant women and women of childbearing age did not differ in their EPA+DHA.
  • Pregnant women consumed less fish than women of childbearing age (perhaps because of concerns about heavy metal contamination).
  • Pregnant women consumed more omega-3 supplements.

In terms of EPA+DHA from supplements:

  • Less than 1% of the American population reported using omega-3 supplements.
  • The one exception was pregnant women. 7.3% of pregnant women reported taking an omega-3 supplement.
  • People taking omega-3 supplements had significantly higher EPA+DHA intake than people not taking omega-3 supplements.
  • This was also true for pregnant women. Those taking omega-3 supplements had higher EPA+DHA intake.

Of course, like any clinical study, it has strengths and weaknesses.

The biggest weakness of this study is that omega-3 intake is based on the participants recall of what they ate. The strengths of the study are its size (45,347 participants) and the fact that its estimate of omega-3 intake is consistent with several smaller studies.

 

Are Americans Deficient In Omega-3s?

 

pregnant women omega 3 deficient questionsNow we are ready to answer the questions I posed at the beginning of this article. Let’s start with the first one: “How deficient are we?”

You would think the answer to that question would be easy. It is not. This study provides a precise estimate of American’s omega-3 intake. The problem is there is no consensus as to how much omega-3s we need. There is no RDA for omega-3s.

There are, in fact, three sets of guidelines for how much omega-3s we need, and they disagree.

  • The World Health Organization (WHO) recommendations for EPA+DHA intake range from 100-150 mg/day at ages 2-4 years to 200-500 mg/day for adults.
  • The US National Institute of Medicine (IOM) recommendations for EPA+DHA intake range from 70 mg/day for ages 1-3 to 110 mg/day for adult females and 160 mg/day for adult males.
  • As if that weren’t confusing enough, an international group of experts recently convened for a “Workshop on the Essentiality of and Recommended Dietary Intakes for Omega-6 and Omega-3 Fatty Acids” (Workshop). This group recommended an EPA+DHA intake of 440 mg/day for adults and 520 mg/day for pregnant and lactating women.

Using these recommendations as guidelines, this study reported that:

  • EPA+DHA intake for children 1-5 years old was ~25% of the WHO recommendations and ~40% of IOM recommendations.
  • EPA+DHA intake for children 6-11 years old was ~27% of WHO recommendations and ~40% of IOM recommendations.
  • EPA+DHA intake for adolescents 12-19 years old was ~50% of IOM recommendations (The WHO did not have a separate category for adolescents.
  • EPA+DHA intake for adults 20-55 years old was ~30% of WHO recommendations, and ~65% of IOM recommendations.
  • EPA+DHA intake for seniors >55 years old was 38% of WHO recommendations and 82% of IOM recommendations.
  • EPA+DHA intake for pregnant women was ~20% of Workshop recommendations (The WHO and IOM did not have a separate category for pregnant women).

While the percentage deficiency varied according to the EPA+DHA guidelines used, it is clear from these results that Americans of all age groups are not getting enough omega-3s from their diet.

The authors concluded: “We found omega-3 intakes across all age groups was lower than recommended amounts.”

 

Are Pregnant Women and Young Children Dangerously Deficient In Omega-3s?

 

danger symbolWhile the authors concluded that all age groups were deficient in omega-3s, they were particularly concerned about the omega-3 deficiencies in pregnant women and young children.

The authors said: “Taken together, these findings demonstrate that low omega-3 fatty acid intake is consistent among the US population and could increase the risk for adverse health outcomes, particularly in vulnerable populations (e.g., young children and pregnant women).”

In part, the focus on young children and pregnant women was based on their very low omega-3 intake. With intakes at 20-27% of recommended levels, I would consider these groups to be dangerously deficient in omega-3s.

pregnant women omega 3 deficient pregnancyHowever, the focus on young children and pregnant women was also based on the seriousness of the adverse health outcomes associated with low omega-3 intake in these population groups. This answers the second question I posed at the beginning of this article: “Does it matter?”

According to the authors low intake of EPA and DHA during pregnancy and early childhood is associated with maternal depression, pre-term births, low birth-weight babies, increased risk of allergies and asthma, problems with learning and cognition, and other neurocognitive outcomes.

None of these associations between low omega-3 intake and adverse health outcomes have been proven beyond a shadow of a doubt, but the evidence is strong enough that we should be alarmed by the very low omega-3 intake in pregnant women and young children.

There is, however, a simple solution. The authors of this study concluded: “Individuals taking EPA/DHA containing supplements had significantly elevated intake compared to individuals not taking omega-3 fatty acid-containing supplements or not reporting any supplement use.”

omega 3 supplementsThey went on to say: “As supplement use is associated with increased omega-3 intake, supplementation could be an important source of EPA/DHA, particularly for pregnant women given their lower fish consumption compared to non-pregnant women of childbearing age.”

I agree. Given the low omega-3 intake in these population group and current guidelines for omega-3 intake. I recommend:

  • Pregnant & lactating women (and women of childbearing age who might become pregnant) take an omega-3 supplement providing around 520 mg of EPA+DHA/day.
  • Young children (ages 1-5) take an omega-3 supplement providing around 100 mg of DHA/day.

Of course, this study also confirmed that Americans of all age groups are not getting enough omega-3s from their diet, and low omega-3 intake may increase the risk of heart disease. Furthermore, recent studies have shown that high purity omega-3 supplements may reduce heart disease risk.

You will find my recommendations for omega-3 supplementation for adults in a previous issue of “Health Tips From the Professor.”

 

The Bottom Line

 

The largest study to date (45,347 participants) measured omega-3 intake for Americans of all ages and compared that to current recommendations for omega-3 intake.

The authors of the study concluded:

  • “We found omega-3 intakes across all age groups was lower than recommended amounts.”
  • “Low omega-3 fatty acid intake … could increase the risk for adverse health outcomes, particularly in vulnerable populations (e.g., young children and pregnant women.”

In part, the focus on young children and pregnant women was based on their very low omega-3 intake. With intakes at 20-27% of recommended levels, I would consider these groups to be dangerously deficient in omega-3s.

However, the focus on young children and pregnant women was also based on the seriousness of the adverse health outcomes associated with low omega-3 intake in these population groups.

  • According to the authors low intake of EPA and DHA during pregnancy and early childhood is associated with maternal depression, pre-term births, low birth-weight babies, increased risk of allergies and asthma, problems with learning and cognition, and other neurocognitive outcomes.

There is, however, a simple solution. The authors of this study also concluded:

  • “Individuals taking EPA/DHA containing supplements had significantly elevated intake compared to individuals not taking omega-3 fatty acid-containing supplements or not reporting any supplement use.”
  • “As supplement use is associated with increased omega-3 intake, supplementation could be an important source of EPA/DHA, particularly for pregnant women given their lower fish consumption compared to non-pregnant women of childbearing age.”

For more details on the study and my recommendations for omega-3 supplementation, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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