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The percentage of heart attack survivors who experienced another one within a year fell between 2008 and 2017, according to research showing the greatest overall decline was in women. Yet, a separate new survey of women shows heart disease awareness also has dipped over the past decade among those younger than 65.

Deaths from heart attacks have been declining since the 1970s, but survivors still are at increased risk to have another heart attack, or to die within a year after they leave the hospital.

The new study, published Monday in the ·¬ÇÑÊÓƵ journal , used Medicare and commercial health insurer data on 1.5 million men and women hospitalized for a heart attack between 2008 and 2017. Researchers then looked at the rates of recurrent heart attacks, procedures to open clogged heart arteries, and hospitalizations to treat heart failure during the first year after hospital discharge.

Though both sexes had declines, the study found repeat heart attacks decreased more steeply in women, from 89.2 per 1,000 person-years – the number of cases that occur in 1,000 people followed for one year – to 72.3. In men, the rate fell from 94.2 to 81.3.

"We expected to see a decline in the rate of events, (but) we did not expect the rates to differ between the sexes," lead author Sanne A.E. Peters said in a news release. She is senior lecturer at The George Institute for Global Health in collaboration with Imperial College London in the United Kingdom.

"It may be that the improvements in men were achieved before our study period, leaving less room for improvement in the most recent decade. It could also be that the attention paid to heart disease in women over recent years has resulted in the greater gains," she said. "However, regardless of the improvements, the rates of recurrent events in people who survived a heart attack are still very high in both sexes. Patients should speak with their doctors to ensure that they get the right treatments to prevent secondary events and must make sure that they adopt or maintain a healthy lifestyle."

Meanwhile, a new survey from the AHA showing 10-year trends in women's awareness of heart disease as their No. 1 killer found awareness declined in the last decade – from 65% in 2009 to 44% in 2019. The drop was observed in all racial, ethnic and age groups, except women ages 65 and older.

The data are the results of a national online survey, published Monday in the AHA journal , of more than 1,500 U.S. women over 25. It was conducted in January of 2009, 2012 and 2019.

"We found that women who were younger versus older, and non-Hispanic Black, Hispanic or Asian versus white had lower awareness that heart disease was the leading cause of death," Dr. Mary Cushman, chair of the report's writing group, said in a news release. She is professor of medicine at Larner College of Medicine at the University of Vermont in Burlington.

Specifically, women 25-34 years old saw an 81% decline in awareness. The survey also highlighted an 86% drop among Hispanic women and a 67% decline in Black women.

Awareness of heart attack symptoms also declined among all women. Only half of women knew chest pain was a symptom, and even fewer identified other symptoms such as shortness of breath and pain that spreads to shoulders, neck or arms.

"This signals an urgent call for organizations ranging from public health, government and health care professionals, to community organizations such as churches and employers to take on the challenge with full gusto to better inform women of their risk for heart disease," said Cushman, who added the message can start at home.

"This survey gives us the data we need to better inform the women in our lives to take charge of their health."

The AHA, she said, is poised to "evolve to reach younger generations of women in new, innovative ways."

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