Silent killer rising: Young women face surge in heart disease deaths

In a study being presented at the American College of Cardiology’s Annual Scientific Session (ACC.26), researchers report that heart disease related to high blood pressure accounts for a growing proportion of deaths among women age 25-44 years, rising from 1.1 to 4.8 per 100,000 deaths among women in this age group between 1999 and 2023.

High blood pressure (hypertension) damages the heart and is an indicator of heart disease risk.

Taking proactive steps to control blood pressure can help prevent life-threatening cardiac events, yet the risks of uncontrolled hypertension may be overlooked among young women and their clinicians.

Previous research has examined hypertensive heart disease risks primarily in men and post-menopausal women; this study is among the first to focus on younger women.

“Rising mortality for young women with hypertensive heart disease reflects an underestimation of cardiovascular risk, delayed diagnosis and missed opportunities for early intervention,” said Alexandra Millhuff, DO, a resident physician at the University of New Mexico and the study’s lead author. “This study underscores the urgent need for specific prevention strategies.”

Lifestyle modifications such as quitting smoking, eating a heart-healthy diet and exercising more are the first steps in managing high blood pressure, with the option to add blood pressure lowering medications if needed. If left unmanaged, having high blood pressure for an extended period can weaken the heart muscle and lead to heart failure, coronary artery disease, heart attacks and strokes. The new ACC/AHA Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults emphasizes the importance of earlier treatment to keep blood pressure below 130/80 mm Hg.

Researchers analyzed death certificate data from U.S. women who died between the ages of 25 years and 44 years to assess rates of death attributed to hypertensive heart disease during the study period.

In 1999, the results showed that hypertensive heart disease accounted for 1.1 of every 100,000 deaths that occurred in young women. By 2023, that rate had risen over fourfold, accounting for 4.8 out of every 100,000 deaths within this population. Over 29,000 women died from hypertensive heart disease-related death during the study period.

The study also revealed striking differences based on factors like race and geography. Non-Hispanic Black women had the highest hypertension-related mortality rate over the study period at 8.6 per 100,000, compared to 2.3 per 100,000 in non-Hispanic White Americans.

Across U.S. regions, women in the South had the highest hypertension-related mortality rate at 3.8 per 100,000, compared to 2.8 in the Midwest, 2.2 in the Northeast and 1.9 in the West. No differences were found among women living in urban versus rural areas.

Many studies have shown that women are prescribed blood pressure lowering medications at lower rates than men, and researchers said that heart disease treatment and awareness efforts have often focused on men or postmenopausal women, with less attention to assessing cardiovascular risk in younger women.

“We need to be screening patients of this demographic for hypertension more aggressively, and that includes mitigating risk factors and possibly using antihypertensive medications,” Millhuff said. “Even though hypertension is more prevalent in older populations, it’s something that we need to be vigilant about in younger populations, as well.”

The researchers said that women face specific cardiovascular risks related to hormonal and other physiological changes that occur during pregnancy and perimenopause. They emphasized the importance of controlling blood pressure and addressing other risk factors to ensure women are in optimal health before going through menopause or considering becoming pregnant.

Since most young women do not regularly see a cardiologist, the researchers emphasized the role of primary care and women’s health providers in screening for and managing hypertension in this patient population. They said that women can play an active role by asking their doctors about their cardiovascular risk and opportunities to better manage their health.