Heart disease is the leading cause of death in the Western world and often develops over many years without clear symptoms. A large, long-term U.S. study recently published in the Journal of the American Heart Association shows that despite changes in lifestyle and risk factors among both women and men in recent decades, men still develop heart disease at a significantly younger age than women. The gap begins as early as the mid-30s.
The study was based on data from the CARDIA project, one of the world’s most important longitudinal studies in cardiovascular health. Researchers followed 5,112 women and men, Black and white participants, aged 18 to 30, and systematically examined for more than 30 years. During follow-up, major cardiovascular events were documented, including heart attacks, strokes, heart failure, catheterizations, bypass surgeries and other cardiovascular incidents.
The findings were clear. Men developed cardiovascular disease earlier than women across almost all measures. A cumulative incidence of 5% for heart disease appeared in men about seven years before women, at an average age of about 50.5 compared with 57.5. By age 50, nearly 5% of men had already experienced a cardiac event, compared with less than 3% of women.
Most of the gap stemmed from coronary heart disease, a condition affecting the coronary arteries that leads to heart attacks. In this category, the difference was even more pronounced, with men reaching a 2% disease rate more than a decade earlier than women. By contrast, no significant gender differences were found for stroke, and the gap in heart failure appeared only later in life.
“Although awareness of heart disease in women has increased in recent years, this study reinforces what we already know,” said Dr. Bella Koifman, a cardiology consultant at Maccabi Healthcare Services. “Cardiovascular disease is more common in men, and according to the study, it also appears at a younger age. Heart attacks occur in men on average about 10 years earlier than in women, and when looking at all cardiovascular diseases, the gap is about seven years.”
Dr. Bella KoifmanPhoto: Maccabi Healthcare ServicesShe explained that the difference is partly due to higher rates of smoking, high blood pressure and elevated cholesterol among men, while women benefit from hormonal protection until menopause. After menopause, risk factors rise and inflammatory processes in blood vessels increase.
Dr. Koifman explains that the long-term follow-up of about 5,000 women and men showed that cardiovascular disease can begin developing in men as early as the fourth decade of life. “That is why the main emphasis must be on early prevention. This includes education for a healthy lifestyle from a young age, lipid testing even in children from high-risk families, and early preparedness, especially for men in their 30s and 40s, with the goal of prevention rather than fear,” she said.
The turning point: Age 35
One of the study’s most significant findings relates to the timing of when risk differences emerge. Until the early 30s, the absolute risk of cardiovascular events was low and similar in women and men. Around age 35, however, the risk curves began to diverge. Event rates over the following decade were consistently higher in men, and this gap persisted throughout the 40s and 50s.
Researchers examined whether the difference could be explained by known risk factors such as blood pressure, cholesterol, blood sugar, smoking, physical activity, weight and diet, based on the American Heart Association’s Life’s Essential 8 metrics. Even after comprehensive adjustment for all these factors, men remained at higher risk for early heart disease.
The researchers emphasized that this finding suggests lifestyle and classic risk factors do not fully explain the gender gap. Broader biological and social factors may also be involved. The paper noted that “Men developed cardiovascular disease earlier than women, with the greatest difference observed for coronary heart disease. Sex differences in cardiovascular disease risk emerged at age 35, persisted through midlife, and were not attenuated by accounting for cardiovascular health."
A critical decade for prevention
The clinical implications are clear. The fourth decade of life is a critical period in which cardiovascular risk assessment should be taken seriously, particularly among men. The fact that risk differences emerge as early as age 35 supports the need to begin risk assessment and preventive interventions at a young age, the researchers wrote in their conclusions.
At the same time, they stressed that this does not diminish the importance of prevention among women. Heart disease remains the leading cause of death for women as well, with risk rising significantly later in life. Still, the new data highlight that for men, the warning bell rings earlier, long before symptoms appear.
The bottom line is clear. Even as lifestyle gaps between women and men narrow, the male heart still begins to wear down sooner. The central message of the study is simple and sharp. Prevention, screening and awareness of heart disease must begin in young men, well before the age at which “heart problems” are usually considered.