From the 1960s to the 2010s, the United States experienced a major reduction in heart disease-related deaths among younger adults -- often called premature cardiac death.
But that decline has slowed significantly since 2010, and the risk of premature cardiovascular death may depend on where you live, according to a study published July 29 in the Journal of the American Heart Association.
The decades of progress, during which the premature heart disease mortality rate among adults aged 35 to 74 plummeted, are "coined as one of the major public health accomplishments of the 20th century," study lead author Zhi-Jie Zheng said in a news release from the American Heart Association.
But those accomplishments may be fading, the new research showed.
In the new study, Zheng's team analyzed county-by-county data from multiple sources across the United States, covering nearly 1.6 million premature cardiac deaths between 1999 and 2017. All of the deaths resulted from heart disease and were among people aged 35 to 74.
Despite the remarkable downturn in premature cardiac deaths before 2010, the researchers discovered that the pace of decline began to slow in 2010 and that certain counties had higher rates due to societal disparities.
Some populations were more at risk for premature cardiac death, based on sex, age, race/ethnicity and wealth, the findings showed.
Twice as many premature cardiac deaths occurred in men than women, and death rates were three times higher among Blacks than Asians or Pacific Islanders.
Differences in socioeconomic factors -- such as income, employment, school enrollment and crime rates -- accounted for about 20% of deaths, and demographic differences accounted for just over one-third.
"Our findings suggest a need for health care policy changes and programs that can identify high-risk, young populations prone to premature cardiac death and support improved cardiac health," said Zheng, who is a professor at Peking University in Beijing.
While overall premature cardiovascular death rates have continued to decline since 2010, despite slowing significantly, the proportion of out-of-hospital deaths has risen, the study authors said.
According to the study, about six out of 10 of the 1.6 million premature cardiac deaths occurred outside of a hospital, and the percentage of out-of-hospital deaths rose from 58% in 1999 to 61.5% in 2017.
"Heart attacks can occur at any age, not just in older persons," Zheng said. "The slower decline in out-of-hospital rates is alarming and warrants more precision targeting and sustained efforts to integrate lifestyle and behavioral interventions that increase heart health and reduce the risk of premature cardiac death."
Two heart specialists who were unconnected to the study said the influence of race and class on death rates is key.
"As the socioeconomic gap continues to expand, those that are at the highest risk for heart disease are also those that are the most impacted with health care-related disparities," said Dr. Satjit Bhusri, a cardiologist at Lenox Hill Hospital in New York City.
Dr. Guy Mintz directs cardiovascular health at Northwell Health's Sandra Atlas Bass Heart Hospital in Manhasset, N.Y. He agreed that it's "no surprise that areas of the country with a large disadvantaged population is associated with a higher rate of premature cardiac death."
Poverty and education levels "have always been associated with poor health outcomes. Add in lack of health insurance or access to health care, and the problem balloons," Mintz said.
He believes education on cardiovascular health within affected communities is crucial. This education "must start in day care centers, schools, after-school programs, sports clubs, churches, community gatherings, barbershops and salons," Mintz said.
Quick access to health care is also key, he added.
"There needs to be ease of access to health care same day appointments," Mintz said. "Patients get lost in phone tree jungles and eventually when someone does answer, many times they are faced with the indifference of the scheduling staff. The message here is simple: The easier the access, the greater the return in terms of patient care."
Outside of genetics, "all cardiac risk factors" -- obesity, diabetes, high blood pressure, high cholesterol -- "can be modified and neutralized," he added.
"We need to roll up our sleeves and bring the battle against cardiovascular disease to the front lines -- to the people in their homes and communities," Mintz said. "Failure is not an option."
The American Heart Association has more on preventing heart disease.
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