While heart disease-related deaths have decreased in the elderly, studies suggest that death rates in younger patients have stagnated or increased slightly. To understand which factors put younger people at higher risk for premature coronary artery disease (CHD), researchers at Brigham and Women’s Hospital and Mayo Clinic analyzed more than 50 risk factors in 28,024 women who participated in the decade-long Women’s Health Study. Women under 55 years of age with type 2 diabetes in particular had a ten-fold higher risk of CHD over the next two decades, with lipoprotein insulin resistance (LPIR) also proving to be a powerful, predictive biomarker. The results will be published in JAMA Cardiology.
Unfortunately, we will see younger and younger people with heart attacks. When a younger person has a cardiovascular event, it affects their future quality of life, productivity, and contribution to society. “
Samia Mora, MD, MHS, C.or corresponding author, Brigham’s Center for Lipid Metabolomics, Preventive Medicine Department and Associate Professor, Harvard Medical School
“Prevention is better than cure, and many risk factors for heart disease are preventable. This study shows the impact of lifestyle on heart health in women of all ages, and especially in younger women,” said Dr. med. Sagar Dugani Internist at the Mayo Clinic Hospital in Rochester, MN. Dr. Dugani is a co-author of the study.
The researchers analyzed approximately 50 biomarkers related to cardiovascular health. Commonly used metrics like low density lipoprotein (LDL) cholesterol (or “bad” cholesterol) and hemoglobin A1C (a measure of blood sugar levels) had much weaker associations with CHD occurrence in women under 55 than LPIR, a newer metric for insulin resistance. LPIR uses a weighted combination of six lipoprotein measurements and is analyzed by special laboratory tests. While LDL cholesterol was only associated with a 40 percent increase in CHD risk in women under the age of 55, LPIR showed a six-fold (600 percent) increase.
“In otherwise healthy women, insulin resistance, type 2 diabetes, and its sister diagnosis, metabolic syndrome, were major contributors to premature coronary events,” said Mora. “Women under 55 years of age with obesity were approximately four times more likely to have coronary events, as were women in that age group who smoked or had high blood pressure. Physical inactivity and family history are also part of the picture.”
Researchers acknowledged that the study’s generalizability was limited – other than its focus on women, who were shown to have worse outcomes than men after premature cardiac events, its participants were over 95 percent white. Mora said the results could be even more dramatic in ethnic and racial groups, which are more common with metabolic syndrome, insulin resistance and diabetes, among others.
“Diabetes is largely preventable, but it is a system-wide problem and we urgently need to explore more strategies to address this problem,” said Mora. “These could be innovative lifestyle-based strategies such as community efforts, greater public health efforts, pathways to medical targeting of metabolic pathways, or new surgical approaches.”
As the prevalence of diabetes and associated risk factors increases dramatically and affects more women than men, researchers stress the urgency to develop effective interventions.
We need new strategies to improve outcomes in these younger people and address the risk of diabetes because we are only now seeing the start of this epidemic, “said Mora.
Brigham and Women’s Hospital
Dugani, SB et al. (2021) Association of lipid, inflammatory and metabolic biomarkers with age at onset for coronary heart disease in women. JAMA cardiology. doi.org/10.1001/jamacardio.2020.7073.