The early turning point when men’s heart risk accelerates

• Men reached a 5% risk of cardiovascular disease roughly seven years earlier than women, revealing a clear and early gap in heart health.
• Coronary heart disease accounted for most of this difference, driving the earlier rise in risk among men.
• Heart disease risk looked similar for men and women until about age 35, when men's risk began to increase more quickly.
• The earlier onset in men cannot be explained by smoking, high blood pressure, or diabetes alone, pointing to additional biological or social influences.

Heart Disease Risk Appears Earlier in Men

Men start developing coronary heart disease years before women do, and the difference can be seen as early as the mid-30s, according to a large, long-term study led by Northwestern Medicine. Coronary heart disease is a major cause of heart attacks.

Based on more than 30 years of follow-up, the findings suggest that heart disease screening and prevention may need to begin earlier in adulthood, especially for men.

"That timing may seem early, but heart disease develops over decades, with early markers detectable in young adulthood," said study senior author Alexa Freedman, assistant professor of preventive medicine at Northwestern University Feinberg School of Medicine.

"Screening at an earlier age can help identify risk factors sooner, enabling preventive strategies that reduce long-term risk."

Why the Male Female Gap Has Not Closed

Previous research has long shown that men tend to develop heart disease earlier than women. Over time, however, common risk factors such as smoking, high blood pressure and diabetes have become more alike between the sexes. Because of this, researchers expected the difference in heart disease timing to shrink.

Instead, the gap remained. That result was unexpected, Freedman said.

To better explain why these differences continue, Freedman and her colleagues say researchers need to look beyond standard measures like cholesterol and blood pressure and consider a wider range of biological and social influences.

The study was published on January 28 in the Journal of The American Heart Association.

Tracking Heart Disease From Young Adulthood

The research team analyzed data from the Coronary Artery Risk Development in Young Adults (CARDIA) study. The project enrolled more than 5,100 Black and white adults between ages 18 and 30 in the mid-1980s and followed them through 2020.

Because participants were healthy at the start, the researchers were able to identify when cardiovascular disease risk first began to separate between men and women. Men reached a 5% rate of cardiovascular disease, defined broadly to include heart attack, stroke and heart failure, about seven years earlier than women (50.5 versus 57.5 years).

Most of this difference was due to coronary heart disease. Men reached a 2% incidence of coronary heart disease more than 10 years earlier than women. Stroke rates were similar for both sexes, and differences in heart failure appeared later in life. "This was still a relatively young sample -- everyone was under 65 at last follow-up -- and stroke and heart failure tend to develop later in life," Freedman explained.

Traditional Risk Factors Do Not Tell the Whole Story

The researchers examined whether common risk factors could explain why men developed heart disease sooner. These included blood pressure, cholesterol, blood sugar, smoking, diet, physical activity and body weight.

While some factors, especially high blood pressure, accounted for part of the difference, overall cardiovascular health did not fully explain the earlier onset in men. This points to the influence of additional biological or social factors.

Age 35 Emerges as a Key Turning Point

One of the most notable findings was when the risk gap began. Men and women had similar cardiovascular risk through their early 30s. Around age 35, men's risk increased more quickly and remained higher through midlife.

Many heart disease prevention and screening efforts focus on adults older than 40. The new results suggest this approach may miss an important early window for action.

The authors point to the American Heart Association's PREVENT risk equations, which can predict heart disease starting at age 30, as a promising tool for earlier intervention.

Gaps in Preventive Care for Young Men

Closing the gap between men and women may be difficult because preventive care use is uneven among U.S. adults ages 18 to 44. Women are more than four times as likely as men to attend routine checkups, largely because of gynecologic and obstetric visits.

"Our findings suggest that encouraging preventive care visits among young men could be an important opportunity to improve heart health and lower cardiovascular disease risk," Freedman said.

She also stressed that cardiovascular disease remains the leading cause of death for both men and women, making prevention essential for everyone.

The study is titled "Sex Differences in Age of Onset of Premature Cardiovascular Disease and Subtypes: The Coronary Artery Risk Development in Young Adults Study." Freedman is supported by the National Heart, Lung, and Blood Institute (K01HL165038). CARDIA is conducted and supported by the National Heart, Lung, and Blood Institute in collaboration with the University of Alabama at Birmingham (75N92023D00002 & 75N92023D00005), Northwestern University (75N92023D00004), University of Minnesota (75N92023D00006) and Kaiser Foundation Research Institute (75N92023D00003).