Observational study finds men develop cardiovascular disease seven years earlier than women — Evidence Review

Men develop cardiovascular disease about seven years earlier than women, according to a large, long-term U.S. study; this sex difference is mainly seen in coronary heart disease and persists even after adjusting for traditional risk factors. Most related studies agree, finding similar patterns in disease onset and emphasizing both biological and sociocultural contributors, as documented in the Journal of the American Heart Association.

• Multiple studies confirm men experience earlier onset of coronary heart disease, with women’s cardiovascular risk increasing sharply after menopause; both biological (hormonal, genetic) and lifestyle factors contribute to these patterns 1 2 4 7 8.
• Research consistently finds that while men develop coronary heart disease sooner, women are at higher risk for other cardiovascular events (like stroke or heart failure) later in life, supporting the need for sex-specific prevention strategies 5 7 8 10.
• Differences in healthcare utilization, risk factor management, and medication prescription between men and women have been documented, affecting both timing and outcomes of cardiovascular disease 3 9.

Study Overview and Key Findings

Cardiovascular disease (CVD) remains the leading cause of death in both men and women, but its onset, manifestations, and risk factors often differ between sexes. The new study addresses a critical gap by closely following a diverse cohort of over 5,000 U.S. adults for more than three decades, tracking not just overall CVD incidence but also the timing and type of events. This nuanced approach allows for a clearer understanding of when and how CVD risk diverges between men and women, and highlights opportunities for earlier intervention, particularly in men.

Property	Value
Study Year	2023
Organization	Hackensack Meridian Jersey Shore University Medical Center, University of Michigan Health Frankel Cardiovascular Center
Journal Name	Journal of the American Heart Association
Population	Black and white adults
Sample Size	n=5,115
Methods	Observational Study
Outcome	Risk of cardiovascular disease by sex and age
Results	Men develop cardiovascular disease 7 years earlier than women.

This study leverages data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, which began in the mid-1980s and followed participants from early adulthood to about age 65. The researchers found that by age 50, 5% of men had developed some form of CVD, while women reached this incidence rate around age 57. The gap was especially pronounced for coronary heart disease, with men reaching a 2% incidence rate about a decade earlier than women. Importantly, these differences persisted even after adjusting for classic risk factors such as BMI, blood pressure, cholesterol, physical activity, smoking, and diet—suggesting that additional biological and social factors are at play.

The study also noted that the age of onset for stroke and heart failure did not differ significantly between sexes. The authors highlight the need for earlier cardiovascular screening and preventive care in men, but caution against underestimating women’s risk, especially as their risk accelerates after menopause.

Literature Review: Related Studies

To place these findings in context, we searched the Consensus database of over 200 million research papers using the following queries:

1. cardiovascular disease gender differences
2. men women cardiovascular disease onset
3. early onset cardiovascular disease risk factors

Below, we summarize key themes and findings from related research:

Topic	Key Findings
What are the biological and sociocultural drivers of sex differences in cardiovascular disease onset?	- Sex hormones, gene expression, and sex chromosomes contribute to differences in onset and type of CVD between men and women 1 2 4 6. - Sociocultural factors, including healthcare utilization and lifestyle, also play a significant role in shaping sex-based CVD risk profiles 1 3 4.
How do clinical manifestations and first presentations of CVD differ by sex?	- Men are more likely to have coronary heart disease as their first cardiovascular event, while women more often present with stroke or heart failure, typically at older ages 7 10. - Overall lifetime risk of CVD is similar, but the type and timing of first events differ by sex 7 8.
Are there differences in risk factor management and medication prescription by sex?	- Women are less likely than men to receive aspirin, statins, and ACE inhibitors, but more likely to be prescribed diuretics 3. - Women utilize more preventive healthcare, but secondary prevention treatments are more common in men, especially in low- and middle-income countries 9.
What are the strongest risk factors for early-onset CVD, and do these differ by sex?	- Diabetes, hypertension, obesity, dyslipidemia, and smoking are major drivers of early-onset CVD in both sexes, but the relative impact may vary 14 15. - High genetic risk and unhealthy lifestyles have a particularly strong effect on early-onset CVD, and lifestyle modification can lower risk 14 15.

What are the biological and sociocultural drivers of sex differences in cardiovascular disease onset?

The related studies consistently emphasize that both biological and sociocultural mechanisms underlie sex differences in CVD onset. For example, sex hormones such as estrogen provide premenopausal women with some cardiovascular protection, a benefit that diminishes after menopause. Genetic and epigenetic factors, as well as differences in immune and metabolic pathways, further contribute to the divergent risk profiles seen between sexes. Sociocultural factors—like healthcare-seeking behavior, exposure to environmental stressors, and lifestyle habits—also shape when and how CVD develops.

• Sex hormones (estrogen and testosterone) and gene expression influence vascular function, metabolism, and disease progression differently in men and women 1 2 4.
• Sociocultural factors, including preventive healthcare use and lifestyle, contribute to sex-based differences in CVD risk 1 3 4.
• The interplay of biological and gender-related factors complicates risk prediction and calls for personalized approaches 1 4 6.
• Cardioprotection in women is substantially reduced in the presence of obesity, diabetes, or after menopause 4 6.

How do clinical manifestations and first presentations of CVD differ by sex?

Research shows that while the overall lifetime risk of developing CVD is similar for men and women, the initial type of cardiovascular event and the age at which it occurs differ. Men are more likely to experience coronary heart disease (e.g., myocardial infarction) as their first CVD manifestation, often at a younger age, whereas women more frequently have stroke or heart failure as their initial event, typically later in life. These patterns highlight the importance of sex-specific prevention and screening strategies.

• Men tend to develop coronary heart disease earlier, while women experience stroke or heart failure as a first event at older ages 7 10.
• The lifetime risk for any CVD is similar across sexes, but the timing and type of initial manifestation differ 7 8.
• Most primary prevention studies have focused on myocardial infarction and stroke, but these are not always the first CVD events, especially in women 10.
• After menopause, women’s risk of coronary events accelerates, reducing the sex gap in later life 8.

Are there differences in risk factor management and medication prescription by sex?

There is substantial evidence that men and women receive different preventive and therapeutic interventions for CVD. Women are less likely to be prescribed certain key medications (e.g., aspirin, statins) but may be more likely to receive others (e.g., diuretics). Preventive healthcare utilization is generally higher among women, particularly in reproductive years, but secondary prevention (post-diagnosis) often lags. These discrepancies can contribute to differences in disease progression and outcomes.

• Women receive fewer prescriptions for aspirin, statins, and ACE inhibitors compared to men, but more diuretics 3.
• Primary prevention efforts (healthy lifestyle, screening) are more common in women, but men receive more secondary prevention after CVD diagnosis 3 9.
• Differences in treatment patterns are more pronounced in low- and middle-income countries 9.
• These disparities may affect both the timing and severity of CVD events across sexes 3 9.

What are the strongest risk factors for early-onset CVD, and do these differ by sex?

Traditional risk factors—such as diabetes, hypertension, dyslipidemia, obesity, and smoking—are major drivers of premature CVD in both men and women, but their relative impact can vary. Early-onset CVD is especially associated with combined high genetic risk and adverse lifestyle factors. Notably, the benefits of lifestyle modification may be greatest in young adults with high genetic risk, regardless of sex.

• Diabetes and insulin resistance are particularly strong predictors of early-onset CVD 14.
• Other modifiable risk factors—hypertension, obesity, dyslipidemia, smoking—confer significant risk in young adults 14 15.
• High genetic risk amplifies the impact of unhealthy lifestyles on early CVD, but lifestyle improvements can significantly reduce incidence 15.
• Early identification and management of high-risk individuals, including sex-specific risk enhancers (like early menopause or preeclampsia in women), can improve prevention 13 14 15.

Future Research Questions

Despite advances in understanding sex differences in CVD onset and progression, several important gaps remain. Future research should explore the mechanisms underlying these differences, optimize prevention and treatment strategies for both sexes, and address limitations related to study design and population diversity.

Research Question	Relevance
What biological mechanisms explain why men develop coronary heart disease earlier than women?	Understanding the precise biological pathways—including hormonal, genetic, and cellular factors—could inform targeted prevention and treatment strategies 1 2 4.
How do pregnancy-related complications and menopause affect women's long-term cardiovascular risk?	Many studies do not account for female-specific risk enhancers such as preeclampsia and menopause, which may significantly alter CVD risk trajectories 6 11 12.
What interventions are most effective for reducing early-onset cardiovascular disease in high-risk young adults?	Evidence suggests early lifestyle modification and risk management are beneficial, but the optimal strategies for different risk profiles and sexes need clarification 13 14 15.
How do differences in healthcare utilization and medication prescription affect sex-based cardiovascular outcomes?	Differences in preventive care, diagnosis, and treatment may influence the timing and severity of CVD events; addressing disparities could improve outcomes 3 9.
Do current risk assessment tools adequately predict cardiovascular risk in women and men?	Most tools were developed primarily in male populations and may not account for sex-specific risk factors or patterns of disease onset 5 6 7.

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This comprehensive review highlights the importance of sex-specific research and interventions in cardiovascular disease, underscoring that both biological and social factors shape risk throughout the lifespan. Ongoing research and tailored prevention strategies are needed to address these complex differences and reduce the burden of CVD in both men and women.