Progress Against Acute MI Deaths in Nonelderly US Adults Has Plateaued

After decades of declines in death from acute MI among people under age 65 in the United States, the pace has stagnated, a new study shows. Importantly, researchers say, there are disparities that make the case for targeted public health interventions in patient subsets and regions.

A plateau in premature acute MI deaths became apparent around 2011, with the groups having the highest rates being middle-aged adults, men, Black adults, and those living in rural areas. While acute MI deaths decreased at a rate of 4.3% per year between 1999 and 2011, they only declined by 2.1% per year between 2011 and 2019.

Senior study author Safi U. Khan, MD (Houston Methodist DeBakey Heart & Vascular Center, TX), told TCTMD that his group was not able to identify anything specific to 2011 that might explain the slowdown. “I think it's a combination of various factors,” Khan said. “There's the social determinants of health, the socioeconomic breakdown, lack of access for rural residents, lack of education, and [signs that] cardiovascular risk profiles have started to get worse.”

In their paper, published online December 22, 2021, in the Journal of the American Heart Association, the researchers point to recent studies of revascularization outcomes and CABG trends indicating that comorbidity profiles in nonelderly adults with acute MI have become increasingly complex. The patterns in acute MI deaths fall on the backdrop of earlier research showing similar slowdowns for progress in overall CVD mortality, which also had an inflection point in 2011.

When you are taking care of your patients, you need to understand their social profile as well as their clinical profile. Safi U. Khan

Led by Sourbha S. Dani, MD (Beth Israel Lahey Health, Burlington, MA), the study included data from the Centers for Disease Control and Prevention’s WONDER death certificate database for 615,848 premature deaths occurring between 1999 and 2019 for which the primary cause was acute MI.

Compared with women, men had acute MI death rates that were almost three times higher (20.0 vs 7.3 per 100,000 person-years), while middle-aged adults (45-64 years of age) had death rates that were astronomically higher than those of younger adults aged 18-44 years (34.9 vs 2.5 per 100,000 person-years, respectively). In Black adults, the rate was 17.5 per 100,000 person-years, as compared with 13.7 in white adults.

States located in the southern part of the Unites States, including Arkansas, Kentucky, Louisiana, Mississippi, and Tennessee, had higher rates of premature acute MI death than states in the western and northeastern areas, such as Colorado, Utah, Vermont, Connecticut, and Alaska. The southern states also had higher overall rates of smoking, hypertension, and hypercholesterolemia. A look at rural and urban counties showed an average annual decline of 4.2% per year in large metro areas versus 2.4% per year in rural counties.

To TCTMD, Khan said the trends are concerning.

“We need to make a difference at the higher levels in terms of public health and more resource allocation to people who are underserved,” he said. The results also have implications for clinicians in routine practice, he added. “When you are taking care of your patients, you need to understand their social profile as well as their clinical profile. There is much that needs to be done both at the individual level as well as at the organizational public health level.”