Rates of Premature Death from CVD Beginning to Plateau after Decades of Progress

Safi Khan, MD, MS

New research from an analysis of data from the Centers for Disease Control and Prevention (CDC) is underling the need for public health interventions to improve cardiovascular outcomes in people younger than 65 years of age.

Results of their study, which included data from more than 600,000 participants, demonstrate rates of heart attacks among younger patients in the US declined by more than 50% from 1999-2019, but the deceleration in premature death rates appears to have plateaued beginning in 2011.

“The cardiovascular risks among adults younger than age 65 has become increasingly complex during the last two decades. Our study focused explicitly on premature deaths due to a heart attack to identify demographic and regional differences, which may help to inform targeted interventions,” said Safi U. Khan, MD, MS, a cardiology fellow at the DeBakey Heart and Vascular Institute at Houston Methodist Hospital, in a statement.

The success made in reducing the risk of cardiovascular disease among US patients has been regarded as one of, if not, the most successful public health efforts of all time. Since the turn of the century, cardiologists, PCPs, advocacy groups, and more have worked in collaboration to address what was a growing crisis. In the past 2 decades, these efforts have led to remarkable progress in reducing rate of cardiovascular disease on a population level.

The current study was designed by Khan and colleagues at United Methodist Hospital to explore the incidence of premature mortality as a result of acute myocardial infarction based on demographic and regional characteristics in the US. With this in mind, investigators designed their study as an analysis of data from the CDC’s WONDER database from 1999-2019. The primary outcomes of interest for the study were the age-adjusted acute myocardial infarction mortality rates per 10,000 persons and the mean annual percentage change from during the study period.

Upon analysis, investigators identified a total of 615,848 premature deaths, which translates to an age-adjusted mortality rate of 13.4 (95% CI, 13.3-13.5) per 100,000 patients. In 1999, the age-adjusted mortality rate was 20.4 per 1000,000 and this decreased to 9.9 per 100,000 in 2019. From 1999-2011, the average annual percent change was -3.4 (95% CI, -4.6 to -4.1) per year and this rate slowed to -2.1 (95% CI, -2.4 to -1.8) per year from 2011-2019, with this decrease consistent across both sexes, all ethnicities, and races, and urban/rural counties.

When assessing rates according to ethnicity and race, results indicated the age-adjusted mortality rates were greater among non-Hispanic Black adults (17.5 [905% CI, 17.4-17.6]) than non-Hispanic White adults (13.7 [95% CI, 13.6-13.8]). When assessing rates according to sex, results indicated the age-adjusted mortality rates were higher run men (20.0 [955 CI, 19.9-20.1]) than women (7.3 [95% CI, 7.2-7.4]), with an average annual percentage change of -3.3 (95% CI, -3.6 to -3.1) per year in women and -3.5 (95% CI, -3.7 to -3.4) in men.

Results indicated the average annual percentage change suggested greater declines in age-adjusted mortality rates were present among large (-4.2 per year [95% CI, -4.4 to -4.0]), and medium/small metros (-3.3 per year [95% CI, -3.5 to -3.1]) than rural counties (-2.4 per year [95% CI, -2.8 to -1.9]). Further analysis suggested age-adjusted mortality rates above the 90th percentile were distributed in Southern states, while those with mortality rates in the 10th percentile or lower were clustered in Western and Northeastern states.

“Recent medical advancements have reduced major adverse cardiovascular outcomes for patients who have had a heart attack, so we were surprised by the deceleration in the decline of premature death rates during the last decade. This concerning trend reflects the growing burden of cardiovascular disease among younger adults,” Khan added.

This study, “Trends in Premature Mortality From Acute Myocardial Infarction in the United States, 1999 to 2019,” was published in the Journal of the American Heart Association.