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Heart disease deaths rising in young women

Cardiovascular Disease in Women
Risk Factors and Prevention

Sophia Antipolis, 10 February 2021:  A nationwide US study has found increasing death rates from heart disease in women under 65. The research is published in European Heart Journal – Quality of Care and Clinical Outcomes, a journal of the European Society of Cardiology (ESC).1 The study found that while death rates from cancer declined every year between 1999 and 2018, after an initial drop, heart disease death rates have been rising since 2010.

“Young women in the US are becoming less healthy, which is now reversing prior improvements in heart disease deaths,” said senior author Dr. Erin Michos of Johns Hopkins University School of Medicine, Baltimore, US. “With worsening epidemics of diabetes and obesity across developed countries, our findings are a warning sign that we need to pay more attention to the health of young women.”

“Women frequently put others’ health and needs before their own, often caring for children and parents and working full-time,” continued Dr. Michos. “But if they have a fatal heart attack, they won’t be there for loved ones. Women must prioritise their own health, especially since heart disease is largely preventable.”

Heart disease is the main cause of death worldwide. In the age group under-65 in developed countries, most deaths are due to cancer and heart disease is the second reason. This study compared heart disease- and cancer-related deaths in women under 65 in the US. The researchers analysed death certificates between 1999 and 2018 from a national database.2

During the 19-year period, the age-adjusted mortality rates for cancer and heart disease were 52.6 and 24.0 per 100,000, respectively. The most common cause of heart disease death was ischaemic heart disease (56%) while respiratory tract/lung cancer (23%) was the leading cause of cancer death.

Across the entire study period, age-adjusted mortality rates decreased for both cancer and heart disease. But while cancer death rates consistently declined throughout the 19 years, heart disease death rates fell initially and then increased between 2010 and 2018. As a result, the absolute mortality gap between cancer and heart disease significantly decreased from 32.7 to 23.0 per 100,000/year. The authors said: “If extreme public health measures are not taken to mitigate cardiovascular risk factors, focusing on high-risk groups, heart disease mortality may supersede cancer to become the leading cause of death in young women.”

First author Dr. Safi Khan of West Virginia University, Morgantown, US said: “More intensive efforts are needed to prevent and treat heart disease in young women to reverse the upsurge in deaths.”

Dr. Michos said: “There is a misconception that women are not at risk for heart disease before the menopause, yet one-third of their cardiovascular problems occur before 65.3 Studies of young heart attack patients show that compared to men, women were less likely than to have been told they were at risk for heart disease before the attack4 and less often received stents and medications.”5

She concluded: “Most heart disease can be avoided with a healthy balanced diet, physical activity, not smoking, and maintaining a healthy blood pressure, blood glucose, cholesterol level and body weight. Just because a woman is before the menopause does not mean she is not at risk. Unfortunately, the first attack can be fatal, so we need to do better with prevention.”



Notes to editor

ESC Press Office
Tel: +33 (0) 7 8531 2036


Funding: Dr. Michos is supported by the Amato Fund for Women’s Cardiovascular Health research at Johns Hopkins University.


Disclosures: None.



1Khan SU, Yedlpati SH, Lone AN, et al. A comparative analysis of premature heart disease- and cancer-related mortality in women in the USA, 1999–2018. Eur Heart J Qual Care Clin Outcomes. 2021. doi:10.1093/ehjqcco/qcaa099.


2The Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) database contains the assigned cause of mortality from all death certificates in the US.

3Sniderman AD, Thanassoulis G, Williams K, et al. Risk of Premature Cardiovascular Disease vs the Number of Premature Cardiovascular Events. JAMA Cardiol. 2016;1:492–494.

4Bucholz EM, Strait KM, Dreyer RP, et al. Sex Differences in Young Patients with Acute Myocardial Infarction: A VIRGO Study Analysis. Eur Heart J Acute Cardiovasc Care. 2017;6:610–622.

5DeFilippis EM, Collins BL, Singh A, et al. Women who experience a myocardial infarction at a young age have worse outcomes compared with men: the Mass General Brigham YOUNG-MI registry. Eur Heart J. 2020;41:4127–4137.


About the European Society of Cardiology

The ESC brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people to live longer, healthier lives.


European Heart Journal – Quality of Care and Clinical Outcomes

European Heart Journal – Quality of Care and Clinical Outcomes publishes original research and topical reviews from health scientists around the world, focusing on quality of care as it affects cardiovascular outcomes in hospitals, as well as at national international levels.