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November 22, 1985

Myocardial Infarction in Women Younger Than 50 Years

Author Affiliations

University of Leeds United Kingdom

JAMA. 1985;254(20):2893. doi:10.1001/jama.1985.03360200043016

To the Editor.—  A striking feature of most risk factors for fatal ischemic heart disease is the pronounced age dependence of the associated mortality ratios. For the major risk factors, including smoking but excepting lack of exercise, mortality ratios fall from high values in young men and women toward, or even below, unity at 80 to 89 years of age. (The mortality ratios for none, slight, and moderate exercisers vs heavy exercisers generally increase with age.) Both rising and falling characteristics are readily explained by a unified theory of growth and disease.1 Theory holds that acute myocardial infarction, the major component of fatal ischemic heart disease occurring in persons younger than 70 years, is initiated in genetically predisposed persons by six somatic gene mutations. This stochastic initiation process is followed by a latent period (about 12 years average in US white males; 24 in females) before death occurs—if it