Men develop cardiovascular disease 7 years before women, study suggests. But why?

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

The difference is driven largely by coronary heart disease, which is caused by plaque buildup in the arteries within the heart. It appears roughly a decade sooner in men than in women.

Cardiovascular disease is an umbrella term that includes conditions such as coronary heart disease, heart failure and stroke. It remains the leading cause of death for both men and women in the United States, but it doesn't manifest at the same time in both sexes.

The new research, published Jan. 28 in the Journal of the American Heart Association, drew on 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 over 30 years.

The researchers found that the risk of cardiovascular disease for men and women begins to diverge around age 35. From that point through middle age, men consistently had a higher risk of cardiovascular disease than women did. That remained true 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 cholesterol (the "bad" kind).

This suggests that some other biological or social factors may contribute to making men more vulnerable to heart disease at younger ages, the study authors say.

"The study supports that men waiting until middle age to assess cardiovascular risk miss a critical window for prevention," said Dr. Brett Sealove, chair of cardiology at Hackensack Meridian Jersey Shore University Medical Center, who was not involved in the study. Men should begin routine heart health screenings in their 30s and focus on managing modifiable risk factors, such as their diet, exercise habits and smoking, he told Live Science in an email.

However, Sealove noted that these new findings should not lead clinicians or patients to overlook women's risk of developing heart disease before age 65.

Dr. Kim Eagle, a cardiologist and director of the University of Michigan Health Frankel Cardiovascular Center, echoed that concern. "The study is not practice-changing and I worry that many may conclude that heart disease is predominantly a male problem," Eagle, who was not involved in the study, told Live Science in an email.

Eagle pointed out that the study found little to no difference between the age at which men and women developed heart failure or stroke. Furthermore, "it is likely that women have an acceleration of heart disease after menopause compared to men which is not captured in this study," he said. "Heart disease kills more women than any other illness. We should not downplay its importance."

The timeline of heart disease

The CARDIA cohort included 5,115 participants from four U.S. cities: Chicago; Minneapolis; Birmingham, Alabama; and Oakland, California. The participants were between 18 and 30 years old when the study began, between 1985 and 1986, and they were followed until August 2020, making the oldest participants about 65 by the end. The researchers collected health information through medical exams and surveys at baseline and then at two, five, seven, 10, 15, 20, 25 and 30 years into the study.

About 5% of the men had developed some form of cardiovascular diseases by age 50, but for women, that same incidence rate was reached around age 57. The largest sex-based gap appeared in coronary heart disease: Men reached a 2% risk of having coronary heart disease 10 years earlier than women did.

By contrast, the researchers found little to no difference between men and women in the age at which stroke occurred. Their heart failure risk was also similar for much of adulthood..

"The long duration of the study coupled with some diversity of people and the fairly large cohort provides us with valuable data on how cardiovascular health changes from the start of adulthood to middle age," Sealove said.

That said, as an observational study, the research cannot prove what factors cause men to develop heart disease earlier than women do, Sealove noted. Rather, it can only draw a link between sex and heart disease risk. In addition, public health guidelines, diagnostic tools and treatments changed substantially over the study period, which could have influenced when the disease was detected or treated, he noted.

Additionally, Eagle found the study's sample size small, and he also pointed out that it did not account for pregnancy-related complications or menopause, or for forms of heart disease that disproportionately affect women, such as conditions involving the smaller coronary arteries. (The authors didn't explicitly note how many of the women in the study were menopausal by its end.)

The study authors suggested that differences in health care use may contribute to the difference in heart disease seen between the sexes. For example, women ages 18 to 44 attend roughly four times as many preventive health care visits as men do, in part due to seeking gynecologic and obstetric care, they wrote in the paper. Encouraging preventive care among young adult men may represent an important opportunity to reduce cardiovascular risk earlier in life, they suggested.

"The relationship between gender and heart disease risk is complex and changes over a lifetime," Sealove said. While men appear to be more vulnerable to earlier heart disease, women's risk rises sharply after menopause as levels of protective estrogen decline.

"The study doesn't show that one gender is more at risk overall," he said. Rather, it highlights when risk peaks across a lifetime.

"At the end of the day, it is important to know that cardiovascular disease is the leading cause of death and disability in women and men," Sealove said, "and everyone should receive regular health screenings and live a heart healthy lifestyle."

IN CONTEXT

IN CONTEXT

Nicoletta Lanese

It's worth flagging that this research lumps together the concepts of sex and gender. It may be that aspects of the observed heart-health gap are related to sex, meaning they could be tied to differences in chromosomes, hormones or other biological attributes that differ between males and females. But some of the gap may be related to gender, which is related to differences in how men and women are socialized, for example. Teasing apart these influences will be necessary to understand why the gap exists.