“Women living in rural areas of the United States have for the first time suffered an increase in premature deaths from CAD,” senior author Federico Moccetti, MD, an interventional cardiologist at Heart Centre Lucerne in Switzerland, said in a statement. “This is in stark contrast to their urban counterparts, who have experienced a virtually uninterrupted reduction in premature coronary artery disease deaths.”

CAD mortality has been higher in rural areas than urban areas since 1999, the authors noted, with the distance between the two increasing over time. For women, that increase has grown especially significant. The team also observed consistently higher CAD mortality rates for black patients than white patients, though this specific surge in premature CAD mortality among  young woman is “driven by a mortality increase in white women beginning in 2009.”

Moccetti et al. concluded that these statistics show why public health efforts need to be focused on CAD risk factors in younger individuals, “especially young women and residents of rural areas.”

“This significant increase in CAD deaths among young women in the rural U.S. is shocking,” Moccetti said in the same statement. “Disparities in the prevention and control of cardiovascular disease risk factors in these communities are likely the reason for this upswing. Blockages in the heart don’t happen overnight. They are the result of decades of exposure to cardiovascular risk factors such as smoking, high blood pressure, high cholesterol, diabetes, obesity, a sedentary lifestyle and poor diet.”