Heart disease risk rises faster for men than women by the mid-30s

By Asuka Koda, CNN

(CNN) — Men develop a greater risk of cardiovascular disease years earlier than women — starting at around age 35, according to a new long-term study.

The report, published Wednesday in the Journal of the American Heart Association, followed more than 5,000 adults from young adulthood and found that men reached clinically significant levels of cardiovascular disease about seven years earlier than women.

Experts advise both men and women to monitor their heart health in early adulthood and to see their doctor regularly.

“Heart disease doesn’t happen overnight; it develops over years. One of the things I think oftentimes people aren’t aware of is that it can start really early in your 30s or 40s,” said study coauthor Dr. Sadiya Khan, professor of cardiovascular epidemiology at Northwestern University Feinberg School of Medicine in Chicago.

“Even if you don’t have heart disease at that time, your risk can start at that time.”

A long-cited “10-year gap” in cardiovascular disease between men and women is driven mostly by coronary heart disease, a narrowing or clogging of the heart’s arteries caused by plaque buildup, in men.

“The 10-year-gap is a commonly cited statistic that men develop heart disease about 10 years before women. A lot of the initial research on that looked specifically at coronary heart disease, a subtype of cardiovascular disease,” said senior study author Alexa Freedman, assistant professor of preventive medicine at Northwestern University Feinberg School of Medicine in Chicago.

The mix of risk factors for cardiovascular disease has changed over time, Freedman noted. “Smoking rates were higher for men, and they have lowered and are now more similar between men and women. Hypertension is now more similar between men and women,” she said.

Freedman’s team wanted to find out whether the gap exists in other types of cardiovascular disease, such as heart failure and stroke. The team examined premature cardiovascular disease, defined as disease occurring before age 65, and analyzed both overall cardiovascular disease and specific subtypes of coronary heart disease, stroke and heart failure.

Tracking heart health from young adulthood

The analysis draws on data from 5,112 Black and White adults across four US states who were enrolled in the Coronary Artery Risk Development in Young Adults study between 1985 and 1986, when they were between 18 and 30 years old.

All participants were healthy and free of cardiovascular disease when they enrolled in the study. Participants have been followed for a median of 34.1 years, with regular clinical exams and surveys; 160 women and 227 men experienced cardiovascular disease events.

Freedman said that participants entered the study well before the onset of most cardiovascular risk, so researchers were able to precisely measure when disease emerged — a major advantage over studies that enroll patients later in life.

The risk gap widens by the mid-30s

One of the study’s most striking findings came from an analysis of rolling 10-year risk windows. Rather than estimating a single lifetime risk, the researchers calculated the probability of developing cardiovascular disease over the next decade at each age.

Up until their early 30s, men and women had similar short-term cardiovascular risk. But at around age 35, the risk began to diverge. Men began to face a consistently higher 10-year risk than women. Case in point: By age 50, the 10-year risk of cardiovascular disease was about 6% for men, compared with roughly 3% for women.

Over the follow-up period, men developed cardiovascular disease earlier than women. By about age 50, 5% of men had developed cardiovascular disease — nearly seven years earlier than women, who reached the same level around age 57.

Specifically for coronary heart disease, the difference in risk between men and women was even more pronounced. “In our study, about 2% of men had developed coronary heart disease by age 48 or so, and for women, they didn’t reach that incidence until closer to 58, so we saw that 10-year gap,” Freedman said.

The study found that this difference was not explained by traditional risk factors such as blood pressure, cholesterol or smoking. However, Dr. Iris Jaffe, the executive director of the Molecular Cardiology Research Institute at Tufts Medical Center, explained that there are still other “social determinants that are hard to factor in.” She was not involved in the new research.

“Women do different kinds of work than men. Women are under different kinds of stress. Those kinds of things were not accounted for,” she said.

Jaffe also said that more research should be done to understand these biological differences. “I study the biology behind all of this, and I think that there’s certainly some biological difference between men and women that explain some of this that we’re only starting to begin to scratch the surface to understand.”

By contrast, the researchers found no meaningful sex difference in stroke risk; men and women reached similar stroke incidence at nearly the same ages. Heart failure also showed little difference early on, but men had a slightly higher incidence rate by age 65.

Despite the results of this paper, Jaffe emphasized that women should still monitor their heart health.

“I worry that a study like this will make women think that they don’t have to worry about their heart health. Ultimately, heart disease is a leading cause of death for women also,” she said. “Everyone should pay more attention in young adulthood to their health and to preventing heart disease.”

This is especially important because women’s risk for heart disease can accelerate after menopause, Khan explained.

“The hypothesis is that estrogen can be protective, so that women may develop risk for heart disease later, by about 10 years, but then after menopause, it catches up,” Khan said. “After menopause, and particularly during that perimenopause period for women, that risk can accelerate.”

The average age of menopause in the US is 52, according to the National Institutes of Health.

Putting prevention into practice

The study arrives as cardiovascular guidelines are slowly shifting toward earlier risk assessment. Updated American Heart Association risk equations now allow clinicians to estimate cardiovascular risk starting at age 30, rather than 40, a move Freedman said is supported by their findings.

The results also raise questions about health care access and utilization. Young adult women tend to have far more preventive care visits than men, largely due to reproductive health care, which may facilitate earlier risk detection and counseling, the study authors wrote.

“Young men are much less likely to see a doctor for routine care in their mid 30s and 40s, so increasing the preventive care visits, particularly for young men, is one way that we could potentially promote heart health and reduce cardiovascular disease risk,” Freedman said.

Jaffe recommended that young adults see a physician at least once a year and have their blood pressure and cholesterol checked. Need more guidance? She suggested that young adults follow the American Heart Association’s Life’s Essential 8, which are actions people can take to maintain healthy cardiovascular health.

“Most of them are to manage the traditional risk factors, like avoiding tobacco, managing your weight, managing blood pressure, blood sugar, cholesterol, but then it includes eating better, being more active and getting healthy sleep,” Jaffe said. “Those are the things that everyone can do to decrease the risk of heart disease.”

Khan added that everyone should track their cholesterol, blood pressure and blood sugar levels. “Know where your risk factors are, you know where your risk is, and then you can act on it,” she said.

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