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Study Indicates Earlier Onset of Cardiovascular Disease Risk in Men, Starting in Mid-30s

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Sex-Based CVD Onset: Men Develop Heart Disease Years Earlier Than Women, Risk Diverges by Mid-30s

A recent study published in the Journal of the American Heart Association has identified significant sex-based differences in the age of onset for premature cardiovascular disease (CVD). The research reports that men develop the condition significantly earlier than women, with risk trajectories beginning to diverge as early as their mid-30s. Tracking over 5,000 individuals for more than three decades, the study indicates that this disparity is largely driven by coronary heart disease.

Study Design and Participants

The research utilized data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a prospective, multicenter cohort that enrolled 5,112 Black and White adults aged 18 to 30 years from four U.S. cities between 1985 and 1986.

  • Participant Tracking: Individuals underwent repeated clinical examinations and health assessments for over 34 years.
  • Outcome Surveillance: Ongoing surveillance for cardiovascular outcomes continued through August 2020. Sex was self-reported at enrollment.
  • Primary Outcome: New-onset, clinically confirmed CVD, encompassing events such as heart attack, stroke, heart failure, or coronary revascularization. Events occurring before the age of 65 were categorized as premature.
  • Health Assessment: Cardiovascular health was assessed using seven metrics from the American Heart Association’s Life’s Essential 8 framework. These included lifestyle and clinical factors such as diet quality, physical activity, smoking status, body mass index, blood pressure, blood lipid levels (non-high-density lipoprotein cholesterol), and glucose levels.

Key Findings: Early Onset and Diverging Risk

The study revealed notable sex-based differences in the timing of premature CVD:

  • Men reached a 5% cumulative incidence of cardiovascular events approximately seven years earlier than women (averaging 50.5 years compared to 57.5 years).
  • By age 50, nearly 5% of men had experienced a cardiovascular event, while less than 3% of women had.
  • The divergence in cardiovascular risk trajectories began around age 35. Prior to their early 30s, both men and women exhibited similarly low absolute risk. However, from approximately age 35 onward, men consistently showed higher 10-year CVD rates than women.

For individuals free of disease at age 50, men demonstrated nearly double the 10-year risk of CVD compared with women.

The Role of Coronary Heart Disease and Other Subtypes

Coronary heart disease (CHD), a condition involving arterial blockages from fatty deposits and a common cause of heart attacks, accounted for most of the observed disparity. Men reached a 2% cumulative incidence of CHD more than 10 years earlier than women.

Regarding other CVD subtypes:

  • Stroke: No significant sex differences were found for the timing and frequency of stroke.
  • Heart Failure: Showed modest sex differences overall, with cumulative incidence diverging later in life and a higher incidence observed among men by age 65. Researchers noted that the study sample was relatively young, with all participants under 65 at the last follow-up, and stroke and heart failure typically manifest later in life.

Understanding the Disparity: Risk Factors and Explanations

The observed gap in risk diminished but did not disappear even after adjusting for time-updated cardiovascular health measures, including blood pressure, cholesterol, blood sugar levels, smoking status, physical activity, and body weight.

This suggests that traditional risk factors do not fully explain why men develop CVD earlier than women. The study did not extensively detail the reasons for this sex discrepancy, but researchers indicated that differences in sex hormones and cholesterol levels may contribute.

Implications for Prevention and Screening

The findings underscore young adulthood as a period for cardiovascular risk assessment and prevention in men, where early intervention may help delay the onset of disease. Heart disease remains a leading cause of death for both men and women.

"Heart disease develops over decades, with early markers detectable in young adulthood," stated epidemiologist Alexa Freedman from Northwestern University. "Screening at an earlier age can help identify risk factors sooner, enabling preventive strategies that reduce long-term risk."

Researchers suggest increased efforts to encourage men to have their heart health assessed at an earlier age, particularly noting that women tend to have more regular health professional visits. Freedman concluded that "encouraging preventive care visits among young men could be an important opportunity to improve heart health and lower cardiovascular disease risk."