Abstract 13107: Contributing Causes to Ischemic Heart Disease (IHD) Death in Young Women: A Multiple Cause of Death Analysis bBsed on New York City (NYC) Vital Statistics
Background IHD mortality rates have declined in all populations except young women. Although IHD in young women is not common, the case fatality rate is higher than for age-matched men. Adverse trends in younger women may be due to higher frequency of IHD associated disorders such as chronic inflammatory and infectious diseases, cocaine use and renal disease. Such disorders may not be affected by typical preventive approaches. Diabetes (DM) is a major IHD risk factor, particularly in women and young adults. We aimed to investigate the frequency of these IHD associated disorders using multiple cause analysis of NYC death certificates of women aged <55 and comparator groups based on sex and age. Methods NYC death certificates were included if the underlying cause was IHD [International Classification of Disease Codes (ICD)-10 I20-25, ICD-9 410-414, 429.2] for decedents aged ≥25 (n=396,994; 1990-2008). Selected contributing causes (lupus, rheumatoid arthritis, cocaine use, HIV, chronic renal disease and DM) were examined. Trends over time were analyzed using Monte Carlo permutation method (Joinpoint). Frequencies of specific contributing causes were compared using z tests of proportion between groups. Results - Figure DM, SLE, cocaine and HIV were reported on a higher proportion of IHD death certificates of women <55 than ≥55. DM was the most frequently reported contributing cause. DM was most commonly reported in women <55 [773/5059 (15%)], as compared to women ≥55 [13136/215762 (6%), p<0.001] and men <55 [1231/12501 (10%), p<0.001]. There were no significant trends over time in contributing cause frequency. Conclusions Women <55 were more likely than women ≥55 to have several examined contributing causes to IHD death. DM may be a particularly potent risk factor for IHD death in women <55. There was no trend over time to explain observed IHD mortality trends. Further clinician awareness of the role of DM and these other disorders in IHD death may improve outcomes in young women.
- © 2012 by American Heart Association, Inc.