Cardiovascular disease risk remains similar in men and women until the mid-30s, then diverges sharply as coronary disease appears earlier in men. Digest
Cardiovascular disease is the leading cause of death in the United States, but men and women do not develop it on the same timeline. To identify when these differences begin, researchers followed a large group of adults from young adulthood into midlife and recorded when their first cardiovascular events occurred.
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The analysis used data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, which enrolled 5,115 adults aged 18 to 30 in the mid-1980s and followed them for more than 30 years. Researchers compared men and women to determine when "premature" cardiovascular disease, defined as occurring before age 65, first appeared. They examined overall cardiovascular disease as well as three major subtypes: coronary heart disease, which involves blocked blood flow to the heart; stroke, caused by disrupted blood flow to the brain; and heart failure, when the heart cannot pump blood effectively. They also assessed whether differences in cardiovascular health factors, such as blood pressure, cholesterol, smoking, and physical activity, accounted for any sex differences.
- The age at which cardiovascular disease had developed in 5 out of every 10 adults occurred about 7 years earlier in men than women.
- Coronary heart disease contributed most to the observed sex difference. The age at which 2 out of every 100 participants had developed coronary heart disease came more than 10 years earlier in men than in women.
- Stroke showed no meaningful difference between men and women, with both reaching similar risk levels at about the same ages.
- Heart failure patterns were also similar at younger ages, although men showed higher risk later in life.
- When researchers examined 10-year risk windows, men and women had nearly identical chances through their 20s and early 30s. From about age 35 onward, male–female differences in 10-year CVD event rates emerged and persisted.
- Adjustment for overall cardiovascular health factors only minimally attenuated the sex difference, with blood pressure accounting for the largest reduction.
Commonly measured risk factors do not fully capture why coronary heart disease occurs earlier in men, pointing to the need for broader investigation beyond standard risk measures. The key insight is timing: the study points to the mid-30s as a critical window when cardiovascular risk in men and women begins to diverge. This suggests that earlier cardiovascular screening and risk assessment, along with preventive efforts such as lifestyle changes and, when appropriate, medication, may be warranted. In Aliquot #105 and Aliquot #109, I discuss lifestyle strategies to improve blood pressure and blood lipid levels.