By Jen Wieczner
Chicago cardiologist Vincent Bufalino can still recount the details of a few particular patients he saw a decade ago: In the span of a single month, a half-dozen men who arrived at his hospital were having heart attacks—and they were all under the age of 33.
At the time, it seemed like an unfortunate coincidence. But it may in fact have been part of a larger trend. There’s growing concern among national health experts that Americans are getting sicker at a younger age, which could potentially lead to more early deaths. Rising rates of obesity among children and adolescents, in particular, will likely lead to more young people having chronic diseases, strokes or heart attacks, doctors and researchers say.
Heart disease deaths overall declined 30% between 2000 and 2010, but for young adults, they actually increased: Deaths from the disease rose more than 5% among 25- to 34-year-olds, the only age group to experience an increase that decade, according to the Department of Health and Human Services’ most recent annual report. In 2011, the same 25-to-34 group was the only demographic for which mortality from any cause increased (data on specific causes has not yet been released).
“There should be decreasing mortality rates, but instead it was going in the opposite direction in this younger age group,” says Christopher O’Donnell, a cardiologist atMassachusetts General Hospital who also works on the National Institutes of Health’s Framingham Heart Study, an ongoing research project.
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Doctors say cardiovascular deaths are often related to risk factors such as obesity, hypertension, diabetes and high cholesterol—all of which are increasing among younger people under 40.
“I can’t help but imagine when you see the incidence of obesity in teenagers and rates of Type 2 diabetes, there’s no question that this population has the potential to be a time bomb in their 40s and 50s,” says Peter Eckman, a cardiologist at the University of Minnesota who specializes in heart failure and transplants. “I have to admit I do expect to see more of that.”
While the national obesity rate has grown more than 50% since the late ’80s and ’90s, to include more than a third of Americans, the rate among 12- to 19-year-olds has increased 75%: Nearly a fifth of adolescents and teens are obese, according to the Health Department’s annual statistics report—and many of them are also on the path toward developing diabetes, research has shown.
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“If you get diabetes when you’re 15, you’re not going to live til the ripe old age of 80—you’re going to have your first heart attack in your 30s, not in your 50s,” Eckman says.
When risk symptoms show up in young adults, they are powerful predictors for the early onset of Type 2 diabetes and heart disease, says Beth Lewis, principal investigator at Cardia, a study of coronary artery risk development in young adults age 18 to 30, also sponsored by the NIH. Even mildly high blood pressure, common among 20-somethings, along with other early risk factors, forewarns of heart failure 15 years later, the study found. “This spells trouble in my book,” she says.
The trend threatens to reverse generations of national health improvements, such as steady declines in death rates and ever-longer lifespans. The problem also has the potential to cause problems for the health reform model, in which the low cost of caring for healthy young people is supposed to balance out the high cost of caring for the sick. The Affordable Care Act, with wellness incentives and wider access to preventive care, is banking on all Americans becoming relatively healthier over time. But if younger generations end up being sicker than older generations—having heart attacks at younger ages, for instance—health experts say, health reforms might prove unsustainably costly.
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“There’s very likely a silent and growing population of people that are going to have these problems and are going to have them earlier, and earlier might mean in their 40s instead of their 50s,” Eckman says.
Indeed, in analyzing employer health plan costs, ADP, a benefits administration and consulting firm, has found that workers’ medical needs typically increase with age. While those expenses traditionally start ramping up at age 40, it happens a little younger now, says ADP vice president Christopher Ryan.
Research suggests that while heart attacks and strokes are declining for middle-age and older adults, that’s not the case for younger adults, says cardiovascular epidemiologist Kirsten Bibbins-Domingo, who directs the Center for Vulnerable Populations at theUniversity of California, San Francisco’s medical school. Between the late ’90s and 2011, the rate of strokes among adults 25 to 44 rose 75%, though it still happens to less than 1% of the age group, according to the national health report. Over the same time period, the rate of heart disease for men 18 to 44 stayed constant, though cardiologists believe it would have decreased, as it has among other age groups, if not for the counteracting trend of obesity.
“We see an astonishingly high amount of young people come in with heart attacks,” O’Donnell says. Fortunately, he says, those attacks are not usually fatal, and heart disease, attacks and related deaths are still much less common in younger people than in older individuals. Furthermore, thanks to medical advances, people today are also much more likely to survive a heart attack.
Cardiologists attribute the overall decline in deaths to the greater use of cholesterol-lowering drugs and surgical interventions. So even if young people don’t die of heart disease, if more get it, it’s still bad news for the health system, which will end up treating patients for a greater portion of their lives. And those costs are already expected to add up to a substantial sum: The American Heart Association projects that the medical costs of coronary heart disease, which totaled nearly $200 billion in 2009 according to the most recent government calculation, will double between 2013 and 2030.
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Pediatricians may start screening for disease risk factors earlier than they have traditionally, but they have limited ability to treat what they find because there is little research on the safety of giving children adult heart medications, which can have side-effects, O’Donnell says: “The-risk-to-benefit evidence is sorely needed in the early adults and even adolescents and children. That’s the challenge.”