Research suggests that men develop cardiovascular disease seven years earlier than women. but why?

Men tend to develop cardiovascular disease about seven years earlier than women, according to a new study.

This difference is primarily caused by coronary heart disease, which is caused by plaque buildup in the arteries within the heart. Symptoms develop about 10 years earlier in men than in women.

Cardiovascular disease is an umbrella term that includes conditions such as coronary heart disease, heart failure, and stroke. Although it remains the leading cause of death in both men and women in the United States, it does not occur at the same time.

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The new study, published Jan. 28 in the Journal of the American Heart Association, used data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, which followed more than 5,000 black and white adults across the United States for more than 30 years.

Researchers found that the risk of cardiovascular disease for men and women begins to diverge around age 35. From that point until midlife, men consistently had a higher risk of cardiovascular disease than women. This trend remained even when the researchers adjusted for common risk factors such as body mass index (BMI), blood pressure, blood sugar levels, physical activity, smoking status, diet quality, and levels of non-HDL (“bad”) cholesterol.

This suggests that some other biological or social factors may contribute to making men more susceptible to heart disease at a younger age, the study authors said.

“This study confirms that men who wait until middle age to assess their cardiovascular risk are missing an important opportunity for prevention,” said Dr. Brett Seelove, chief of cardiology at Hackensack Meridian Jersey Shore University Medical Center, who was not involved in the study. Men should start getting regular heart health checkups in their 30s and focus on managing modifiable risk factors such as diet, exercise habits, and smoking, he told Live Science via email.

However, Dr. Seelove noted that these new findings should not cause clinicians and patients to overlook the risk of women developing heart disease before age 65.

Dr. Kim Eagle, a cardiologist and director of the Frankel Heart and Vascular Center at Michigan Health University, expressed similar concerns. “I’m concerned that this study will not change practice and that many will conclude that heart disease is primarily a men’s problem,” Eagle, who was not involved in the study, told Live Science via email.

Eagle noted that the study found little or no difference in the age at which men and women develop heart failure or stroke. Additionally, “women are more likely than men to have accelerated heart disease after menopause, which was not captured in this study,” she said. “Heart disease kills more women than any other disease, and we should not underestimate its importance.”

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heart disease timeline

The CARDIA cohort included 5,115 participants from four U.S. cities. Minneapolis; Birmingham, Alabama. and Oakland, California. Participants were between 18 and 30 years old at the start of the study (1985-1986) and were followed until August 2020, with the oldest participant finally being approximately 65 years old. Researchers collected health information through medical examinations and surveys at baseline and 2, 5, 7, 10, 15, 20, 25, and 30 years after the study began.

About 5% of men had developed some form of cardiovascular disease by age 50, while the same rate for women reached around age 57. The biggest gender difference was in coronary heart disease, where men had a 2% risk of developing coronary heart disease 10 years earlier than women.

In contrast, researchers found little difference between men and women in the age at which stroke occurred. Their risk of heart failure remained similar throughout most of their adult lives.

“The long study period, combined with the diversity of people and a fairly large cohort, provided valuable data about how cardiovascular health changes from early adulthood to middle age,” said Seelove.

However, Sealove noted that because it was an observational study, the study could not prove what causes men to develop heart disease earlier than women. Rather, they can only draw an association between gender and heart disease risk. Additionally, he noted that public health guidelines, diagnostic tools, and treatments have changed significantly over the study period, which may have affected when the disease was detected and treated.

Additionally, Dr. Eagle found the study’s small sample size and noted that it did not take into account forms of heart disease that disproportionately affect women, such as pregnancy-related complications, menopause, or conditions involving smaller coronary arteries. (The authors did not explicitly state how many of the women who participated in the study had reached menopause by the end of the study.)

The study authors suggested that differences in health care utilization may contribute to the differences in heart disease seen between men and women. For example, women between the ages of 18 and 44 attend about four times as many preventive health clinics as men, sometimes seeking gynecological or obstetric care, they wrote in the paper. Encouraging preventive care among young adult men may represent an important opportunity to reduce cardiovascular risk early in life, the researchers suggested.

“The relationship between gender and heart disease risk is complex and changes throughout the lifespan,” says Seelove. Men seem to be more susceptible to heart disease earlier in life, but women’s risk increases sharply after menopause as their levels of protective estrogen decline.

“This study does not show that either gender is at higher risk overall,” he said. Rather, it emphasizes when risk peaks throughout the lifespan.

“At the end of the day, it’s important to know that cardiovascular disease is the leading cause of death and disability in women and men, and everyone should get regular health checkups and live a heart-healthy lifestyle,” said Seelove.

in context

in context

Nicoletta Lanese

health channel editor

It’s worth warning that this study lumps together the concepts of sex and gender. Aspects of the observed heart and health gap may be related to gender. That is, they may be associated with differences in chromosomes, hormones, or other biological attributes that differ between men and women. However, some of the gap may be gender-related, for example, related to differences in the way men and women are socialized. Distinguishing between these effects is necessary to understand why the gap exists.